- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,949.84 / $4,786.30
| Facility | | $323.59 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $812.83 / $1,949.84 / $6,456.54
| Facility | 50 | $812.83 | $1,949.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $154.88 / $446.68
| Professional | | $56.23 | $154.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $724.44
| Professional | 50 | $218.78 | $309.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $257.04 / $478.63
| Facility | | $58.88 | $257.04 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $128.82 / $331.13
| Professional | | $45.71 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $245.47
| Professional | | $56.23 | $104.71 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $162.18 / $1,445.44
| Facility | | $60.26 | $162.18 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $1,148.15
| Professional | | $91.20 | $154.88 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $933.25 / $2,137.96
| Facility | | $112.20 | $933.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $204.17
| Professional | | $53.70 | $93.33 | $204.17 |