- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $426.58 / $1,659.59
| Facility | | $79.43 | $426.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $707.95 / $741.31
| Facility | 50 | $562.34 | $707.95 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $234.42
| Professional | | $56.23 | $95.50 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $234.42 / $512.86
| Professional | 50 | $114.82 | $234.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $131.83
| Professional | | $72.44 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $204.17
| Professional | 50 | $104.71 | $158.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $204.17
| Professional | | $64.57 | $107.15 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $398.11
| Facility | | $81.28 | $81.28 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $169.82
| Professional | | $66.07 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $186.21
| Professional | | $125.89 | $125.89 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $144.54
| Facility | | $57.54 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $169.82
| Professional | | $79.43 | $128.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $724.44 / $1,949.84
| Facility | | $234.42 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $141.25
| Professional | | $51.29 | $77.62 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,951.21 / $2,951.21
| Facility | | $56.23 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $707.95
| Professional | | $630.96 | $630.96 | $707.95 |