- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $371.54 / $1,202.26
| Facility | | $66.07 | $371.54 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,445.44
| Facility | 50 | $426.58 | $660.69 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $165.96
| Professional | | $41.69 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $61.66 / $141.25 / $295.12
| Professional | 50 | $61.66 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $158.49
| Professional | | $87.10 | $117.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $190.55
| Professional | 22 | $104.71 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $239.88
| Professional | 50 | $131.83 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $173.78
| Professional | | $60.26 | $114.82 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $83.18 / $524.81
| Facility | | $45.71 | $83.18 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $549.54 / $691.83
| Facility | 50 | $363.08 | $549.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $316.23
| Professional | | $72.44 | $123.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $295.12
| Professional | 50 | $125.89 | $234.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,819.70 / $2,041.74
| Facility | | $616.60 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $151.36
| Professional | | $50.12 | $89.13 | $151.36 |