- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $257.04 / $7,585.78
| Facility | | $87.10 | $257.04 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $165.96
| Professional | | $64.57 | $87.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $457.09 / $489.78
| Professional | 50 | $371.54 | $457.09 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $56.23
| Facility | | $54.95 | $54.95 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $123.03 / $239.88
| Professional | | $89.13 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $602.56
| Facility | | $83.18 | $83.18 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $194.98
| Professional | | $79.43 | $112.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $204.17
| Professional | | $134.90 | $134.90 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $169.82
| Facility | | $64.57 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $169.82
| Professional | | $95.50 | $128.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $724.44 / $1,949.84
| Facility | | $234.42 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $162.18
| Professional | | $63.10 | $91.20 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $416.87 / $416.87
| Facility | | $56.23 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $758.58
| Professional | | $676.08 | $676.08 | $758.58 |