- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $831.76 / $5,888.44
| Facility | | $64.57 | $831.76 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $275.42 / $707.95 / $1,621.81
| Facility | 50 | $275.42 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $229.09
| Professional | | $39.81 | $79.43 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $331.13
| Professional | 50 | $72.44 | $128.82 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,715.35 / $9,549.93
| Facility | | $1,380.38 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $61.66 / $125.89
| Professional | | $37.15 | $61.66 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $177.83
| Professional | 50 | $53.70 | $91.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $177.83 / $512.86
| Facility | | $34.67 | $177.83 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $144.54
| Professional | | $42.66 | $69.18 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,023.29 / $3,311.31
| Facility | | $245.47 | $1,023.29 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $60.26 / $131.83
| Professional | | $36.31 | $60.26 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $138.04
| Professional | 50 | $91.20 | $138.04 | $138.04 |