- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $3,801.89 / $12,589.25
| Facility | | $489.78 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $234.42 / $616.60
| Professional | | $45.71 | $234.42 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | 50 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,659.59 / $3,388.44
| Facility | | $1,318.26 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $100.00 / $467.74
| Professional | | $44.67 | $100.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $223.87 / $794.33
| Professional | | $89.13 | $223.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $371.54 / $831.76
| Facility | | $61.66 | $371.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $2,290.87
| Professional | | $331.13 | $588.84 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $457.09 / $812.83
| Professional | | $102.33 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $524.81 / $812.83
| Professional | | $100.00 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,548.82 / $4,466.84
| Facility | | $371.54 | $1,548.82 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $302.00 / $630.96
| Professional | | $61.66 | $302.00 | $630.96 |