- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $891.25 / $1,819.70
| Facility | | $158.49 | $891.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $870.96 / $1,148.15 / $3,715.35
| Facility | 50 | $870.96 | $1,148.15 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $354.81
| Professional | | $117.49 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $575.44 / $575.44
| Professional | 50 | $131.83 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $912.01
| Facility | | $831.76 | $831.76 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $3,467.37
| Facility | | $812.83 | $812.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $316.23
| Professional | | $147.91 | $229.09 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,630.27 / $5,128.61
| Facility | | $812.83 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $416.87
| Professional | | $147.91 | $181.97 | $416.87 |