- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $1,819.70 / $5,754.40
| Facility | | $38.02 | $1,819.70 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $194.98
| Professional | | $32.36 | $64.57 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $162.18 / $281.84
| Professional | 50 | $64.57 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $47.86 / $57.54
| Professional | | $14.13 | $47.86 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $66.07
| Professional | | $33.88 | $42.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $100.00
| Professional | 50 | $51.29 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $51.29 / $69.18
| Professional | | $31.62 | $51.29 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $95.50
| Professional | | $37.15 | $57.54 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $57.54 / $758.58
| Facility | | $35.48 | $57.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $81.28 / $380.19
| Professional | | $47.86 | $81.28 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $549.54 / $1,698.24
| Facility | | $245.47 | $549.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $85.11
| Professional | | $34.67 | $54.95 | $85.11 |