- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $645.65 / $1,071.52
| Facility | | $263.03 | $645.65 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $645.65
| Facility | 50 | $616.60 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $147.91
| Professional | | $34.67 | $67.61 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $229.09
| Professional | 50 | $154.88 | $213.80 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $81.28 / $165.96
| Professional | | $37.15 | $81.28 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $109.65 / $645.65
| Facility | | $42.66 | $109.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $616.60 / $645.65
| Facility | 50 | $338.84 | $616.60 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $141.25 / $269.15
| Professional | | $54.95 | $141.25 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $223.87 / $229.09
| Professional | 50 | $69.18 | $223.87 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $275.42
| Professional | | $144.54 | $218.78 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $72.44 / $257.04
| Facility | | $38.02 | $72.44 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $125.89
| Professional | | $45.71 | $66.07 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $169.82 / $269.15
| Professional | | $40.74 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |