- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $3,715.35 / $6,606.93
| Facility | | $194.98 | $3,715.35 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $4,677.35
| Facility | 50 | $1,122.02 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $112.20 / $295.12
| Professional | | $57.54 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $60.26 / $338.84 / $1,071.52
| Professional | 50 | $60.26 | $338.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $831.76 / $1,584.89
| Facility | | $194.98 | $831.76 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $177.83
| Professional | | $44.67 | $81.28 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $194.98
| Professional | | $61.66 | $102.33 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $112.20 / $1,659.59
| Facility | | $61.66 | $112.20 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $123.03 / $1,096.48
| Professional | | $69.18 | $123.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,258.93 / $3,235.94
| Facility | | $602.56 | $1,258.93 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $158.49
| Professional | | $54.95 | $81.28 | $158.49 |