- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,454.71 / $7,244.36
| Facility | | $316.23 | $2,454.71 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | 50 | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $138.04 / $426.58
| Professional | | $46.77 | $138.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | 50 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $588.84 / $851.14
| Facility | | $426.58 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $269.15 / $371.54
| Professional | | $46.77 | $269.15 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $70.79
| Facility | | $60.26 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $426.58
| Professional | | $52.48 | $89.13 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $346.74 / $1,548.82
| Facility | | $58.88 | $346.74 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $2,290.87
| Professional | | $263.03 | $398.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $602.56 / $1,584.89
| Facility | | $138.04 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $213.80 / $436.52
| Professional | | $46.77 | $213.80 | $436.52 |