- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $1,862.09 / $7,413.10
| Facility | | $102.33 | $1,862.09 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $977.24 / $1,380.38 / $2,089.30
| Facility | 50 | $977.24 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $208.93
| Professional | | $54.95 | $91.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $316.23
| Professional | 50 | $83.18 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $61.66 / $97.72
| Professional | | $54.95 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $147.91
| Professional | 50 | $67.61 | $104.71 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,047.13 / $1,122.02
| Facility | | $323.59 | $1,047.13 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $169.82
| Professional | | $109.65 | $109.65 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $173.78
| Professional | | $67.61 | $107.15 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $478.63
| Facility | | $56.23 | $114.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $2,754.23
| Professional | | $95.50 | $147.91 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $537.03 / $2,818.38
| Facility | | $165.96 | $537.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $151.36
| Professional | | $64.57 | $97.72 | $151.36 |