- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $489.78 / $1,412.54
| Facility | | $72.44 | $489.78 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $645.65 / $758.58
| Facility | 50 | $302.00 | $645.65 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $91.20 / $257.04
| Professional | | $43.65 | $91.20 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $281.84 / $630.96 / $954.99
| Professional | 22 | $281.84 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $446.68
| Professional | 50 | $77.62 | $154.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $389.05 / $758.58
| Facility | | $147.91 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $213.80 / $588.84 / $1,148.15
| Facility | 50 | $213.80 | $588.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $128.82
| Professional | | $75.86 | $93.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $194.98
| Professional | 50 | $109.65 | $134.90 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Facility | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $107.15
| Professional | | $51.29 | $72.44 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $107.15 / $645.65
| Facility | | $51.29 | $107.15 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $758.58
| Facility | 50 | $302.00 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $100.00 / $173.78
| Professional | | $51.29 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $281.84 / $630.96 / $954.99
| Professional | 22 | $281.84 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $154.88 / $436.52
| Professional | 50 | $69.18 | $154.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $954.99
| Facility | | $537.03 | $660.69 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $1,096.48 / $1,412.54
| Facility | 50 | $794.33 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $131.83
| Professional | | $77.62 | $95.50 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $281.84
| Professional | | $57.54 | $83.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $123.03
| Professional | | $51.29 | $79.43 | $123.03 |