- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $489.78
| Facility | | $245.47 | $457.09 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $524.81 / $912.01
| Facility | 50 | $512.86 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $87.10 / $147.91
| Professional | | $26.92 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | 50 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $91.20 / $275.42
| Professional | | $18.62 | $91.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $144.54 / $457.09
| Facility | | $28.84 | $144.54 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $95.50 / $524.81 / $977.24
| Facility | 50 | $95.50 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $131.83 / $363.08
| Professional | | $57.54 | $131.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | 50 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $309.03 / $467.74
| Professional | | $107.15 | $309.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $112.20 / $416.87
| Facility | | $28.18 | $112.20 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $74.13 / $208.93
| Professional | | $38.02 | $74.13 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $138.04 / $446.68
| Professional | | $46.77 | $138.04 | $446.68 |