- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,071.52 / $2,398.83
| Facility | | $234.42 | $1,071.52 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $1,023.29 / $4,365.16
| Facility | 50 | $660.69 | $1,023.29 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $549.54
| Professional | | $181.97 | $316.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $44.67 / $389.05 / $1,096.48
| Professional | 50 | $44.67 | $389.05 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $3,981.07
| Facility | | $2,884.03 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $389.05
| Professional | | $177.83 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $645.65
| Professional | | $346.74 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $575.44
| Professional | | $245.47 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $147.91 / $295.12
| Professional | | $131.83 | $147.91 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $562.34 / $1,202.26
| Professional | 50 | $218.78 | $562.34 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,398.83 / $7,079.46
| Facility | | $1,023.29 | $2,398.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $537.03
| Professional | | $169.82 | $316.23 | $537.03 |