- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $3,467.37 / $5,623.41
| Facility | | $48.98 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $138.04
| Professional | | $32.36 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $181.97 / $288.40
| Professional | 50 | $64.57 | $181.97 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $58.88
| Professional | | $30.90 | $46.77 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $107.15
| Professional | 50 | $42.66 | $66.07 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,466.84 / $8,709.64
| Facility | | $1,949.84 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $57.54
| Professional | | $28.84 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $85.11
| Professional | 50 | $43.65 | $51.29 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $44.67
| Facility | | $30.90 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $66.07
| Professional | | $45.71 | $58.88 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $97.72
| Facility | | $36.31 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $83.18
| Professional | | $36.31 | $52.48 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,137.96 / $7,413.10
| Facility | | $257.04 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $85.11
| Professional | | $31.62 | $47.86 | $85.11 |