- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $1,513.56 / $6,309.57
| Facility | | $165.96 | $1,513.56 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 50 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $117.49 / $245.47
| Professional | | $45.71 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 50 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $43.65
| Professional | | $38.90 | $38.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $125.89 / $213.80
| Professional | | $48.98 | $125.89 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $229.09
| Facility | | $165.96 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $151.36 / $234.42
| Professional | | $54.95 | $151.36 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $181.97 / $1,548.82
| Facility | | $54.95 | $181.97 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $1,778.28
| Professional | | $134.90 | $190.55 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $602.56 / $1,584.89
| Facility | | $138.04 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $114.82 / $223.87
| Professional | | $48.98 | $114.82 | $223.87 |