- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $199.53 / $446.68
| Professional | | $75.86 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $380.19 / $630.96
| Professional | 50 | $120.23 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $588.84 / $1,071.52
| Facility | | $131.83 | $588.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $154.88 / $309.03
| Professional | | $57.54 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $177.83 / $346.74
| Professional | | $83.18 | $177.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $208.93 / $1,862.09
| Facility | | $79.43 | $208.93 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 52 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $1,905.46
| Professional | | $190.55 | $275.42 | $1,905.46 |
- 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
- $75.86 / $173.78 / $316.23
| Professional | | $75.86 | $173.78 | $316.23 |