- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $2,089.30 / $7,585.78
| Facility | | $109.65 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $446.68 / $2,238.72 / $5,888.44
| Facility | 50 | $446.68 | $2,238.72 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $251.19
| Professional | | $57.54 | $102.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $371.54 / $524.81
| Professional | 50 | $79.43 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,630.78 / $9,120.11
| Facility | | $1,445.44 | $3,630.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $186.21
| Professional | | $57.54 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $275.42
| Professional | 50 | $87.10 | $138.04 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $346.74 / $870.96
| Facility | | $95.50 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $275.42
| Professional | | $67.61 | $128.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,778.28 / $4,365.16
| Facility | | $562.34 | $1,778.28 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $229.09
| Professional | | $57.54 | $104.71 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $229.09 / $229.09
| Professional | 50 | $104.71 | $229.09 | $229.09 |