- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $245.47 / $416.87
| Facility | | $67.61 | $245.47 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $251.19
| Professional | | $38.90 | $74.13 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $97.72
| Professional | 50 | $46.77 | $46.77 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $436.52 / $977.24
| Facility | | $173.78 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $1,380.38
| Facility | 50 | $302.00 | $489.78 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $131.83 / $251.19
| Professional | | $74.13 | $131.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $199.53 / $371.54
| Professional | 50 | $112.20 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $257.04 / $616.60
| Facility | | $181.97 | $257.04 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $295.12
| Professional | | $89.13 | $162.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $489.78
| Facility | | $199.53 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $275.42
| Professional | | $89.13 | $151.36 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $144.54 / $478.63
| Facility | | $53.70 | $144.54 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $549.54
| Facility | 50 | $114.82 | $114.82 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $158.49 / $354.81
| Professional | | $69.18 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $354.81
| Professional | 50 | $346.74 | $346.74 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,778.28 / $3,715.35
| Facility | | $354.81 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $223.87
| Professional | | $51.29 | $97.72 | $223.87 |