- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $645.65 / $1,737.80
| Facility | | $72.44 | $645.65 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,174.90
| Facility | 50 | $478.63 | $691.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $77.62 / $165.96
| Professional | | $44.67 | $77.62 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $263.03
| Professional | 50 | $69.18 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $85.11
| Professional | | $39.81 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $93.33 / $123.03
| Professional | 50 | $83.18 | $93.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $537.03
| Facility | | $331.13 | $389.05 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $501.19 / $588.84 / $794.33
| Facility | 50 | $501.19 | $588.84 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $83.18
| Professional | | $42.66 | $61.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $131.83
| Professional | | $45.71 | $69.18 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $549.54 / $1,348.96
| Facility | | $239.88 | $549.54 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $109.65
| Professional | | $38.02 | $57.54 | $109.65 |