- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $2,511.89 / $7,413.10
| Facility | | $32.36 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $125.89
| Professional | | $29.51 | $54.95 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $70.79
| Professional | 50 | $42.66 | $42.66 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,570.88 / $8,912.51
| Facility | | $2,238.72 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $74.13
| Professional | | $38.02 | $51.29 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $112.20
| Professional | 50 | $57.54 | $75.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $74.13
| Professional | | $25.12 | $30.20 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $52.48 / $144.54
| Professional | | $26.92 | $52.48 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $81.28 / $1,288.25
| Facility | | $32.36 | $81.28 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $60.26 / $831.76
| Professional | | $36.31 | $60.26 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $537.03 / $1,513.56
| Facility | | $107.15 | $537.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $74.13
| Professional | | $28.18 | $44.67 | $74.13 |