- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,380.38 / $5,623.41
| Facility | | $190.55 | $1,380.38 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $758.58 / $3,981.07 / $7,762.47
| Facility | 50 | $758.58 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $676.08
| Professional | | $173.78 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $371.54 / $831.76
| Professional | 50 | $48.98 | $371.54 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,677.35 / $8,317.64
| Facility | | $2,238.72 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $616.60
| Professional | | $190.55 | $363.08 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $549.54 / $933.25
| Professional | 50 | $288.40 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $288.40 / $524.81
| Professional | | $158.49 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $630.96
| Professional | | $194.98 | $363.08 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $588.84 / $16,218.10
| Facility | | $218.78 | $588.84 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $4,466.84
| Facility | 50 | $1,737.80 | $2,511.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $3,801.89
| Professional | | $288.40 | $512.86 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,630.27 / $4,365.16
| Facility | | $1,819.70 | $2,630.27 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $549.54
| Professional | | $199.53 | $346.74 | $549.54 |