- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $616.60 / $5,370.32
| Facility | | $112.20 | $616.60 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,454.71 / $4,168.69
| Facility | 50 | $2,187.76 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $125.89 / $346.74
| Professional | | $56.23 | $125.89 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $812.83
| Professional | 50 | $117.49 | $281.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $251.19
| Professional | | $89.13 | $165.96 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $407.38
| Professional | | $69.18 | $120.23 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $1,148.15
| Facility | | $95.50 | $190.55 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $741.31
| Professional | | $95.50 | $186.21 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $724.44 / $1,348.96
| Professional | 50 | $331.13 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $251.19
| Professional | | $141.25 | $208.93 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $346.74
| Professional | | $151.36 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $109.65 / $213.80
| Professional | | $53.70 | $109.65 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $954.99 / $2,344.23
| Facility | | $457.09 | $954.99 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $234.42
| Professional | | $64.57 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $223.87
| Professional | | $114.82 | $151.36 | $223.87 |