- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $1,096.48 / $1,737.80
| Facility | | $131.83 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $354.81 / $831.76 / $2,630.27
| Facility | 50 | $354.81 | $831.76 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $169.82 / $380.19
| Professional | | $77.62 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $275.42 / $1,047.13
| Professional | 50 | $117.49 | $275.42 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $158.49
| Professional | | $70.79 | $125.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $426.58
| Professional | 50 | $104.71 | $117.49 | $426.58 |
- 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
- $60.26 / $117.49 / $199.53
| Professional | | $60.26 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $158.49 / $309.03
| Professional | | $87.10 | $158.49 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $588.84 / $1,348.96
| Facility | | $251.19 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $295.12
| Professional | | $69.18 | $131.83 | $295.12 |