- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $3,019.95 / $8,128.31
| Facility | | $81.28 | $3,019.95 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $75.86 / $263.03
| Professional | | $23.99 | $75.86 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $208.93
| Professional | 50 | $158.49 | $158.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.88 / $37.15
| Professional | | $32.36 | $33.88 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,995.26 / $11,220.18
| Facility | | $446.68 | $1,995.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $223.87
| Professional | | $22.91 | $35.48 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $323.59
| Facility | | $41.69 | $41.69 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $54.95 / $257.04
| Professional | | $23.99 | $54.95 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,388.44 / $7,585.78
| Facility | | $2,290.87 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $208.93
| Professional | | $24.55 | $40.74 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $91.20
| Professional | | $32.36 | $34.67 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,290.87 / $5,011.87
| Facility | | $588.84 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $64.57 / $239.88
| Professional | | $23.44 | $64.57 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $60.26
| Professional | | $34.67 | $34.67 | $60.26 |