- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,862.09 / $5,011.87
| Facility | | $245.47 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $1,071.52 / $1,071.52
| Facility | 50 | $676.08 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $204.17 / $691.83
| Professional | | $57.54 | $204.17 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $257.04 / $831.76
| Professional | 50 | $81.28 | $257.04 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $234.42 / $251.19
| Professional | | $50.12 | $234.42 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $79.43 / $380.19
| Professional | 50 | $69.18 | $79.43 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $125.89
| Professional | | $64.57 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $389.05 / $426.58
| Professional | 50 | $97.72 | $389.05 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $169.82 / $371.54
| Professional | | $61.66 | $169.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $81.28 / $323.59
| Professional | | $1.70 | $81.28 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $75.86 / $380.19
| Professional | | $1.45 | $75.86 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $251.19 / $389.05
| Professional | | $50.12 | $251.19 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $1,047.13 / $2,041.74
| Facility | | $120.23 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $162.18 / $346.74
| Professional | | $57.54 | $162.18 | $346.74 |