- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $831.76 / $2,511.89
| Facility | | $97.72 | $831.76 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $1,122.02 / $3,630.78
| Facility | 50 | $933.25 | $1,122.02 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $398.11
| Professional | | $77.62 | $158.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $269.15 / $831.76
| Professional | 50 | $117.49 | $269.15 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $891.25
| Facility | | $660.69 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $117.49 / $229.09
| Professional | | $89.13 | $117.49 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $302.00
| Facility | | $107.15 | $107.15 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $309.03
| Professional | | $93.33 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $331.13
| Professional | | $128.82 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $229.09 / $478.63
| Professional | 50 | $208.93 | $229.09 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $346.74 / $776.25
| Facility | | $128.82 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $295.12
| Professional | | $77.62 | $154.88 | $295.12 |