- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $1,288.25 / $5,495.41
| Facility | | $70.79 | $1,288.25 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $4,466.84
| Facility | 50 | $2,137.96 | $2,137.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $239.88 / $630.96
| Professional | | $46.77 | $239.88 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $912.01
| Professional | 50 | $165.96 | $371.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $117.49
| Professional | | $70.79 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | 50 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $295.12 / $870.96
| Professional | | $77.62 | $295.12 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $204.17 / $676.08
| Professional | | $56.23 | $204.17 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $245.47 / $616.60
| Facility | | $51.29 | $245.47 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $676.08 / $1,348.96
| Professional | | $380.19 | $676.08 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $724.44 / $1,949.84
| Facility | | $363.08 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $257.04 / $602.56
| Professional | | $48.98 | $257.04 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $8,709.64 / $8,709.64
| Facility | | $56.23 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | | $2,398.83 | $2,398.83 | $2,398.83 |