- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $4,677.35 / $7,413.10
| Facility | | $239.88 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,659.59 / $7,413.10 / $7,413.10
| Facility | 50 | $1,659.59 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $199.53 / $407.38
| Professional | | $79.43 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $660.69
| Professional | 50 | $128.82 | $229.09 | $660.69 |
- 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
- $85.11 / $117.49 / $190.55
| Professional | | $85.11 | $117.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $295.12
| Professional | 50 | $89.13 | $128.82 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $691.83 / $2,137.96
| Facility | | $144.54 | $691.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $398.11
| Professional | | $89.13 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $257.04 / $1,380.38
| Professional | | $77.62 | $257.04 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $229.09 / $257.04
| Professional | | $77.62 | $229.09 | $257.04 |
- 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
- $89.13 / $181.97 / $371.54
| Professional | | $89.13 | $181.97 | $371.54 |