- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $676.08 / $977.24
| Facility | | $338.84 | $676.08 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $724.44 / $724.44
| Facility | 50 | $426.58 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $162.18
| Professional | | $37.15 | $72.44 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $724.44
| Professional | 50 | $158.49 | $229.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $85.11 / $169.82
| Professional | | $38.90 | $85.11 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $154.88 / $758.58
| Facility | | $46.77 | $154.88 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $724.44
| Facility | 50 | $426.58 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $141.25 / $281.84
| Professional | | $57.54 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $512.86 / $758.58
| Professional | 50 | $69.18 | $512.86 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $223.87 / $288.40
| Professional | | $147.91 | $223.87 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $75.86 / $263.03
| Facility | | $38.90 | $75.86 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $131.83
| Professional | | $47.86 | $69.18 | $131.83 |
- 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
- $41.69 / $181.97 / $302.00
| Professional | | $41.69 | $181.97 | $302.00 |