- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $645.65 / $1,737.80
| Facility | | $173.78 | $645.65 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $1,380.38 / $3,467.37
| Facility | 50 | $398.11 | $1,380.38 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $169.82 / $263.03
| Professional | | $77.62 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $275.42
| Professional | 50 | $117.49 | $263.03 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $141.25
| Facility | | $85.11 | $102.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $309.03 / $354.81
| Professional | | $144.54 | $309.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $141.25 / $141.25
| Facility | | $34.67 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $173.78 / $2,290.87
| Professional | | $81.28 | $173.78 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $812.83 / $2,630.27
| Facility | | $173.78 | $812.83 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $389.05 / $1,348.96
| Facility | 50 | $338.84 | $389.05 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $186.21
| Professional | | $123.03 | $123.03 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $123.03 / $288.40
| Professional | | $66.07 | $123.03 | $288.40 |