- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $269.15 / $8,511.38
| Facility | | $263.03 | $269.15 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $3,388.44 / $15,135.61
| Facility | 50 | $575.44 | $3,388.44 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $831.76
| Professional | | $263.03 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $281.84 / $467.74 / $891.25
| Professional | 50 | $281.84 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $676.08
| Professional | | $457.09 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $1,023.29
| Professional | 50 | $691.83 | $851.14 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $794.33
| Professional | | $380.19 | $489.78 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $794.33
| Facility | | $263.03 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.58 / $0.65 / $14,454.40
| Facility | 50 | $0.58 | $0.65 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $616.60
| Professional | | $275.42 | $478.63 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,128.61 / $5,128.61
| Facility | | $4,677.35 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $660.69
| Professional | | $275.42 | $436.52 | $660.69 |