- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,445.44 / $2,570.40
| Facility | | $562.34 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 50 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $371.54 / $1,122.02
| Professional | | $95.50 | $371.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $138.04 / $323.59 / $3,467.37
| Professional | 50 | $138.04 | $323.59 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $112.20
| Professional | | $58.88 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | 50 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,454.71 / $3,311.31
| Facility | | $2,089.30 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,090.30 / $3,715.35 / $5,011.87
| Facility | 50 | $3,090.30 | $3,715.35 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $398.11 / $707.95
| Professional | | $72.44 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $407.38 / $912.01
| Professional | | $107.15 | $407.38 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,202.26 / $2,511.89
| Facility | | $457.09 | $1,202.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $407.38 / $724.44
| Professional | | $83.18 | $407.38 | $724.44 |