- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $2,290.87 / $5,888.44
| Facility | | $223.87 | $2,290.87 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 50 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $85.11 / $245.47
| Professional | | $40.74 | $85.11 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $144.54 / $309.03
| Professional | 50 | $72.44 | $144.54 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,162.28 / $11,748.98
| Facility | | $2,137.96 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $95.50 / $147.91
| Professional | | $45.71 | $95.50 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $144.54 / $218.78
| Professional | 50 | $67.61 | $144.54 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $489.78 / $549.54
| Facility | | $91.20 | $489.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $138.04
| Professional | | $53.70 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $194.98
| Professional | | $72.44 | $97.72 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $812.83
| Facility | | $588.84 | $588.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $112.20 / $288.40
| Professional | | $61.66 | $112.20 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,981.07 / $7,079.46
| Facility | | $1,288.25 | $3,981.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $144.54
| Professional | | $38.90 | $72.44 | $144.54 |