- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $2,041.74 / $4,897.79
| Facility | | $147.91 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $114.82 / $194.98
| Professional | | $39.81 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | 50 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $120.23
| Professional | | $97.72 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 50 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $144.54
| Professional | | $39.81 | $54.95 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $83.18 / $218.78
| Professional | 50 | $72.44 | $83.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $114.82 / $213.80
| Professional | | $39.81 | $114.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $2,041.74 / $4,897.79
| Facility | | $162.18 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $144.54 / $223.87
| Professional | | $46.77 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $91.20 / $199.53
| Professional | | $39.81 | $91.20 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $912.01 / $1,698.24
| Facility | | $323.59 | $912.01 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $134.90 / $218.78
| Professional | | $51.29 | $134.90 | $218.78 |