- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $912.01 / $3,801.89
| Facility | | $74.13 | $912.01 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $239.88
| Professional | | $63.10 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | 50 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $91.20
| Professional | | $64.57 | $79.43 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $4,265.80
| Facility | | $1,479.11 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $74.13 / $107.15
| Professional | | $61.66 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $112.20 / $162.18
| Professional | 50 | $93.33 | $112.20 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $87.10 / $114.82
| Facility | | $67.61 | $87.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $165.96 / $199.53
| Professional | | $83.18 | $165.96 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $123.03 / $123.03
| Facility | | $34.67 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $169.82 / $724.44
| Professional | | $81.28 | $169.82 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $95.50
| Professional | | $32.36 | $33.11 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,445.44 / $2,630.27
| Facility | | $389.05 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $204.17
| Professional | | $61.66 | $117.49 | $204.17 |