- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $2,238.72 / $5,623.41
| Facility | | $112.20 | $2,238.72 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $630.96
| Facility | 50 | $338.84 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $74.13 / $199.53
| Professional | | $34.67 | $74.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $151.36 / $331.13
| Professional | 50 | $70.79 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $48.98 / $58.88
| Professional | | $24.55 | $48.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $74.13 / $79.43 / $87.10
| Professional | 50 | $74.13 | $79.43 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,862.09 / $3,388.44
| Facility | | $416.87 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $125.89
| Professional | | $41.69 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $89.13
| Professional | | $35.48 | $54.95 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $57.54 / $1,412.54
| Facility | | $35.48 | $57.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $69.18 / $398.11
| Professional | | $44.67 | $69.18 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $251.19
| Professional | 50 | $141.25 | $141.25 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $933.25 / $2,137.96
| Facility | | $263.03 | $933.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $81.28
| Professional | | $33.11 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |