- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $1,778.28 / $7,585.78
| Facility | | $158.49 | $1,778.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $1,479.11 / $4,786.30
| Facility | 50 | $630.96 | $1,479.11 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $125.89 / $407.38
| Professional | | $72.44 | $125.89 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $724.44
| Professional | 50 | $128.82 | $213.80 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,801.89 / $9,549.93
| Facility | | $1,584.89 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $380.19
| Professional | | $95.50 | $158.49 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $218.78 / $467.74
| Professional | 50 | $141.25 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $354.81 / $870.96
| Facility | | $63.10 | $354.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $363.08
| Professional | | $93.33 | $169.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,023.29 / $3,235.94
| Facility | | $251.19 | $1,023.29 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $281.84
| Professional | | $87.10 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $309.03
| Professional | 50 | $89.13 | $89.13 | $309.03 |