- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $2,398.83 / $7,762.47
| Facility | | $218.78 | $2,398.83 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $912.01 / $3,467.37 / $7,413.10
| Facility | 50 | $912.01 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $190.55 / $467.74
| Professional | | $77.62 | $190.55 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $229.09 / $741.31
| Professional | 50 | $141.25 | $229.09 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,630.78 / $9,120.11
| Facility | | $1,445.44 | $3,630.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $288.40
| Professional | | $69.18 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $199.53 / $416.87
| Professional | 50 | $104.71 | $199.53 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $676.08 / $1,737.80
| Facility | | $120.23 | $676.08 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $208.93 / $512.86
| Professional | | $87.10 | $208.93 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,819.70 / $4,365.16
| Facility | | $660.69 | $1,819.70 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $177.83 / $389.05
| Professional | | $74.13 | $177.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |