- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $1,096.48 / $5,888.44
| Facility | | $89.13 | $1,096.48 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $831.76 / $2,344.23 / $5,888.44
| Facility | 50 | $831.76 | $2,344.23 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $181.97 / $446.68
| Professional | | $87.10 | $181.97 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $338.84 / $891.25
| Professional | 50 | $131.83 | $338.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $204.17
| Professional | | $93.33 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $323.59
| Professional | 50 | $97.72 | $141.25 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $2,137.96
| Facility | | $154.88 | $154.88 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $190.55 / $331.13
| Professional | | $107.15 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $199.53 / $1,819.70
| Professional | | $83.18 | $199.53 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $177.83 / $199.53
| Professional | | $83.18 | $177.83 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,290.87 / $3,890.45
| Facility | | $1,174.90 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $181.97 / $331.13
| Professional | | $97.72 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $371.54
| Professional | 50 | $363.08 | $363.08 | $371.54 |