- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $1,174.90 / $4,897.79
| Facility | | $54.95 | $1,174.90 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $2,344.23 / $3,548.13
| Facility | 50 | $204.17 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $162.18
| Professional | | $37.15 | $69.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $407.38
| Professional | 50 | $61.66 | $131.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $58.88
| Professional | | $26.30 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Professional | 50 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $93.33
| Professional | | $40.74 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $141.25
| Professional | 50 | $60.26 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $77.62
| Professional | | $33.88 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $102.33
| Professional | | $41.69 | $63.10 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $75.86 / $1,230.27
| Facility | | $37.15 | $75.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 50 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $407.38
| Professional | | $51.29 | $83.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $208.93
| Professional | 50 | $63.10 | $114.82 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $549.54 / $1,698.24
| Facility | | $245.47 | $549.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $89.13
| Professional | | $37.15 | $53.70 | $89.13 |