- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $630.96 / $2,398.83
| Facility | | $97.72 | $630.96 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $2,089.30 / $2,691.53
| Facility | 50 | $676.08 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $190.55
| Professional | | $85.11 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $288.40 / $288.40
| Professional | 50 | $128.82 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $109.65 / $144.54
| Facility | | $95.50 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $114.82 / $245.47
| Professional | | $102.33 | $114.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $154.88 / $154.88
| Facility | | $34.67 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $3,235.94
| Professional | | $87.10 | $147.91 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $707.95 / $1,318.26
| Facility | | $288.40 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $1,412.54 / $2,187.76
| Facility | 50 | $575.44 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $213.80
| Professional | | $109.65 | $151.36 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $338.84
| Professional | 50 | $234.42 | $316.23 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $933.25
| Facility | | $457.09 | $457.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $302.00
| Professional | | $77.62 | $158.49 | $302.00 |