- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $1,288.25 / $5,623.41
| Facility | | $91.20 | $1,288.25 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $1,778.28 / $2,570.40
| Facility | 50 | $549.54 | $1,778.28 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $199.53 / $741.31
| Professional | | $63.10 | $199.53 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $95.50 / $213.80 / $616.60
| Professional | 50 | $95.50 | $213.80 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $223.87
| Professional | | $63.10 | $63.10 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 50 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $128.82
| Professional | | $61.66 | $77.62 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $190.55
| Professional | 50 | $93.33 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $245.47 / $338.84
| Professional | | $60.26 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $169.82 / $389.05
| Professional | | $74.13 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $239.88 / $660.69
| Facility | | $60.26 | $239.88 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $2,041.74
| Professional | | $181.97 | $323.59 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $707.95 / $2,041.74
| Facility | | $338.84 | $707.95 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $162.18 / $338.84
| Professional | | $69.18 | $162.18 | $338.84 |