- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $4,677.35 / $10,471.29
| Facility | | $549.54 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,454.71 / $6,456.54 / $6,456.54
| Facility | 50 | $2,454.71 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $229.09
| Professional | | $38.90 | $74.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $151.36 / $338.84
| Professional | 50 | $81.28 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $67.61
| Professional | | $63.10 | $64.57 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $8,317.64 / $15,135.61
| Facility | | $537.03 | $8,317.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $162.18
| Professional | | $50.12 | $74.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $69.18 / $154.88
| Professional | | $40.74 | $69.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $102.33
| Professional | | $52.48 | $74.13 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $1,548.82
| Facility | | $602.56 | $954.99 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $60.26 / $162.18
| Professional | | $31.62 | $60.26 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,630.27 / $6,606.93
| Facility | | $1,318.26 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $123.03
| Professional | | $32.36 | $53.70 | $123.03 |