- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $851.14 / $1,737.80
| Facility | | $97.72 | $851.14 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $954.99 / $954.99
| Facility | 50 | $794.33 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $109.65 / $257.04
| Professional | | $57.54 | $109.65 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $281.84 / $549.54
| Professional | 50 | $131.83 | $281.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $128.82
| Professional | | $48.98 | $89.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $194.98
| Professional | 50 | $74.13 | $144.54 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $812.83 / $1,096.48
| Facility | | $676.08 | $812.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,023.29 / $1,202.26 / $1,621.81
| Facility | 50 | $1,023.29 | $1,202.26 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $125.89
| Professional | | $63.10 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $104.71 / $199.53
| Professional | | $63.10 | $104.71 | $199.53 |
- 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
- $50.12 / $83.18 / $154.88
| Professional | | $50.12 | $83.18 | $154.88 |