- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $1,698.24 / $5,623.41
| Facility | | $69.18 | $1,698.24 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $812.83 / $1,862.09
| Facility | 50 | $204.17 | $812.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $302.00
| Professional | | $56.23 | $104.71 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $208.93 / $562.34
| Professional | 50 | $114.82 | $208.93 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $3,981.07
| Facility | | $676.08 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $125.89
| Professional | | $60.26 | $81.28 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $190.55
| Professional | 50 | $91.20 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $120.23
| Professional | | $51.29 | $89.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $147.91
| Professional | | $63.10 | $93.33 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $741.31
| Facility | | $54.95 | $95.50 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $616.60
| Professional | | $75.86 | $120.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Professional | 50 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $549.54 / $1,698.24
| Facility | | $245.47 | $549.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $131.83
| Professional | | $54.95 | $81.28 | $131.83 |