- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,995.26 / $6,918.31
| Facility | | $194.98 | $1,995.26 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $851.14 / $2,630.27 / $6,165.95
| Facility | 50 | $851.14 | $2,630.27 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $549.54
| Professional | | $102.33 | $194.98 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $346.74 / $1,096.48
| Professional | 50 | $162.18 | $346.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,630.78 / $9,120.11
| Facility | | $1,513.56 | $3,630.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $316.23
| Professional | | $97.72 | $162.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $239.88 / $457.09
| Professional | 50 | $141.25 | $239.88 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $630.96 / $1,737.80
| Facility | | $177.83 | $630.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $223.87 / $478.63
| Professional | | $117.49 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,862.09 / $4,466.84
| Facility | | $660.69 | $1,862.09 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $190.55 / $407.38
| Professional | | $97.72 | $190.55 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | 50 | $416.87 | $416.87 | $416.87 |