- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $501.19 / $1,202.26
| Facility | | $51.29 | $501.19 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $501.19 / $4,897.79
| Facility | 50 | $199.53 | $501.19 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $114.82
| Professional | | $33.88 | $64.57 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $114.82 / $173.78
| Professional | 50 | $46.77 | $114.82 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $61.66
| Facility | | $37.15 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $120.23
| Professional | | $48.98 | $104.71 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $60.26
| Facility | | $34.67 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $316.23
| Professional | | $34.67 | $60.26 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $707.95 / $1,148.15
| Facility | | $281.84 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $1,174.90 / $1,949.84
| Facility | 50 | $302.00 | $1,174.90 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $87.10
| Professional | | $50.12 | $79.43 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $120.23 / $151.36
| Professional | 50 | $107.15 | $120.23 | $151.36 |
- 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
- $32.36 / $52.48 / $87.10
| Professional | | $32.36 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |