- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $239.88 / $478.63
| Facility | | $40.74 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $407.38 / $478.63
| Facility | 50 | $120.23 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $72.44 / $131.83
| Professional | | $25.12 | $72.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $120.23 / $354.81
| Professional | 50 | $33.11 | $120.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $64.57
| Professional | | $27.54 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.20 / $44.67 / $138.04
| Professional | 50 | $18.20 | $44.67 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $295.12
| Facility | | $45.71 | $45.71 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $151.36
| Professional | | $30.90 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $87.10 / $194.98
| Professional | | $23.44 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $87.10 / $93.33
| Professional | | $23.44 | $87.10 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,479.11 / $2,691.53
| Facility | | $676.08 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $64.57 / $147.91
| Professional | | $27.54 | $64.57 | $147.91 |