- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $602.56 / $1,096.48
| Facility | | $11.22 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.39 / $1,548.82 / $1,995.26
| Facility | 50 | $22.39 | $1,548.82 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $97.72 / $173.78
| Professional | | $54.95 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $181.97 / $186.21
| Professional | 50 | $83.18 | $181.97 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $97.72
| Facility | | $58.88 | $70.79 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $162.18 / $186.21
| Professional | | $75.86 | $162.18 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $95.50 / $95.50
| Facility | | $34.67 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $389.05
| Professional | | $54.95 | $91.20 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $602.56 / $1,071.52
| Facility | | $37.15 | $602.56 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $831.76 / $1,862.09
| Facility | 50 | $416.87 | $831.76 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $186.21
| Professional | | $109.65 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $190.55 / $204.17
| Professional | 50 | $181.97 | $190.55 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $851.14
| Facility | | $457.09 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $131.83
| Professional | | $50.12 | $79.43 | $131.83 |