- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $83.18 / $7,585.78
| Facility | | $20.89 | $83.18 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | 50 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $109.65
| Professional | | $18.20 | $32.36 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $26.92 / $67.61 / $263.03
| Professional | 50 | $26.92 | $67.61 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $63.10 / $107.15
| Professional | | $20.89 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $51.29 / $102.33
| Professional | | $26.30 | $51.29 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $97.72
| Facility | | $19.05 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $776.25 / $1,949.84
| Facility | | $173.78 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $47.86 / $89.13
| Professional | | $23.99 | $47.86 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $1,288.25
| Facility | | $56.23 | $56.23 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $660.69
| Professional | | $407.38 | $660.69 | $660.69 |