- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $66.07 / $363.08
| Facility | | $26.92 | $66.07 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $194.98
| Facility | 50 | $83.18 | $83.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $61.66 / $154.88
| Professional | | $25.70 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $31.62 / $125.89 / $380.19
| Professional | 50 | $31.62 | $125.89 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $74.13 / $169.82
| Professional | | $47.86 | $74.13 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $75.86 / $151.36
| Professional | | $27.54 | $75.86 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $107.15 / $1,148.15
| Facility | | $43.65 | $107.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 50 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $371.54
| Professional | | $57.54 | $102.33 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $169.82
| Professional | | $63.10 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $100.00 / $169.82
| Professional | | $69.18 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $57.54 / $128.82
| Professional | | $25.12 | $57.54 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $562.34 / $2,344.23
| Facility | | $245.47 | $562.34 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $61.66 / $144.54
| Professional | | $30.20 | $61.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $141.25
| Professional | | $50.12 | $58.88 | $141.25 |