- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $416.87 / $4,265.80
| Facility | | $109.65 | $416.87 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 50 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $120.23 / $269.15
| Professional | | $46.77 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $691.83
| Professional | 50 | $125.89 | $144.54 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $562.34
| Facility | | $234.42 | $380.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $354.81 / $575.44 / $870.96
| Facility | 50 | $354.81 | $575.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $239.88 / $309.03
| Professional | | $85.11 | $239.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $446.68 / $467.74
| Professional | 50 | $128.82 | $446.68 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $154.88 / $302.00
| Professional | | $61.66 | $154.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $831.76 / $831.76
| Professional | | $794.33 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $165.96 / $436.52
| Facility | | $51.29 | $165.96 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 50 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $144.54 / $346.74
| Professional | | $66.07 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $478.63 / $691.83
| Professional | 50 | $125.89 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $102.33
| Professional | | $32.36 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $346.74
| Professional | | $83.18 | $123.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $144.54 / $331.13
| Professional | | $81.28 | $144.54 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $138.04 / $275.42
| Professional | | $52.48 | $138.04 | $275.42 |