- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $3,388.44 / $10,715.19
| Facility | | $32.36 | $3,388.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $91.20
| Professional | | $30.90 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $131.83
| Professional | 50 | $53.70 | $95.50 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $4,265.80 / $12,302.69
| Facility | | $40.74 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $58.88
| Professional | | $30.20 | $38.02 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $53.70 / $114.82
| Professional | | $27.54 | $53.70 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,090.30 / $6,309.57
| Facility | | $2,089.30 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $67.61
| Professional | | $26.30 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $42.66
| Professional | | $27.54 | $33.11 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,412.54 / $3,630.78
| Facility | | $269.15 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $89.13
| Professional | | $32.36 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $38.90
| Professional | | $27.54 | $28.84 | $38.90 |