- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $85.11 / $2,137.96
| Facility | | $42.66 | $85.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $79.43
| Facility | 50 | $69.18 | $69.18 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $50.12 / $151.36
| Professional | | $30.20 | $50.12 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $245.47 / $309.03
| Professional | 50 | $70.79 | $245.47 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $281.84 / $457.09
| Facility | | $79.43 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $63.10
| Professional | | $32.36 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $89.13
| Professional | | $38.02 | $56.23 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $67.61
| Professional | | $32.36 | $33.11 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $114.82
| Facility | | $34.67 | $56.23 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $89.13
| Professional | | $38.90 | $60.26 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $1,096.48 / $1,412.54
| Facility | | $114.82 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $89.13
| Professional | | $38.02 | $57.54 | $89.13 |