- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $3,548.13 / $7,413.10
| Facility | | $229.09 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 50 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $316.23
| Professional | | $107.15 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $562.34 / $2,344.23
| Professional | 50 | $72.44 | $562.34 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $223.87
| Professional | 50 | $190.55 | $190.55 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,398.83 / $4,168.69
| Facility | | $794.33 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $251.19
| Professional | | $95.50 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $380.19
| Professional | 50 | $154.88 | $245.47 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $208.93 / $389.05
| Professional | | $120.23 | $208.93 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $288.40
| Professional | | $104.71 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $398.11
| Professional | | $281.84 | $338.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $346.74
| Professional | | $109.65 | $190.55 | $346.74 |