- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $147.91 / $645.65
| Facility | | $26.30 | $147.91 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $138.04 / $831.76 / $2,454.71
| Facility | 50 | $138.04 | $831.76 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $57.54 / $141.25
| Professional | | $25.12 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $97.72 / $354.81
| Professional | 50 | $69.18 | $97.72 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $72.44
| Professional | | $28.84 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $109.65
| Professional | 50 | $43.65 | $64.57 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $60.26 / $81.28
| Professional | | $24.55 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $63.10 / $109.65
| Professional | | $31.62 | $63.10 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $63.10 / $575.44
| Facility | | $29.51 | $63.10 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $478.63
| Professional | | $56.23 | $91.20 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $537.03 / $1,513.56
| Facility | | $128.82 | $537.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $53.70 / $93.33
| Professional | | $27.54 | $53.70 | $93.33 |