- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $602.56 / $7,244.36
| Facility | | $83.18 | $602.56 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $107.15 / $316.23
| Professional | | $52.48 | $107.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $338.84 / $338.84
| Professional | 50 | $288.40 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $234.42
| Professional | | $117.49 | $173.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $151.36 / $331.13
| Professional | | $66.07 | $151.36 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $1,621.81
| Facility | | $125.89 | $234.42 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $416.87
| Professional | | $102.33 | $177.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $234.42
| Professional | | $117.49 | $181.97 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $275.42
| Professional | | $123.03 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $204.17 / $338.84
| Professional | | $5.01 | $204.17 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,023.29 / $2,344.23
| Facility | | $302.00 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $117.49 / $223.87
| Professional | | $58.88 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $177.83
| Professional | | $97.72 | $114.82 | $177.83 |