- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $371.54 / $5,754.40
| Facility | | $81.28 | $371.54 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $389.05 / $389.05
| Facility | 50 | $162.18 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $213.80
| Professional | | $56.23 | $91.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $204.17 / $616.60
| Professional | 50 | $107.15 | $204.17 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $162.18
| Professional | | $61.66 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $245.47
| Professional | 50 | $91.20 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $1,047.13
| Professional | | $54.95 | $81.28 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $154.88
| Professional | | $57.54 | $85.11 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $128.82
| Professional | | $85.11 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $186.21
| Professional | | $102.33 | $125.89 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $138.04
| Facility | | $56.23 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $1,288.25
| Facility | | $52.48 | $74.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $1,288.25
| Professional | | $70.79 | $100.00 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,344.23
| Facility | | $204.17 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $134.90
| Professional | | $48.98 | $81.28 | $134.90 |