- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $204.17 / $436.52
| Facility | | $56.23 | $204.17 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $302.00 / $891.25
| Facility | 50 | $109.65 | $302.00 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $69.18 / $141.25
| Professional | | $25.12 | $69.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $138.04 / $239.88
| Professional | 50 | $42.66 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $77.62 / $93.33
| Professional | | $38.02 | $77.62 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $112.20 / $234.42
| Professional | 50 | $42.66 | $112.20 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $4,168.69 / $12,302.69
| Facility | | $69.18 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $64.57 / $93.33
| Professional | | $22.91 | $64.57 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $77.62
| Facility | | $45.71 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $67.61 / $141.25
| Professional | | $22.91 | $67.61 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,089.30 / $3,467.37
| Facility | | $1,412.54 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $95.50
| Professional | | $48.98 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $107.15
| Professional | | $19.95 | $33.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,445.44 / $3,630.78
| Facility | | $194.98 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $54.95 / $125.89
| Professional | | $19.50 | $54.95 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $66.07 / $87.10
| Professional | | $19.95 | $66.07 | $87.10 |