- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $173.78 / $389.05
| Facility | | $54.95 | $173.78 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $380.19
| Facility | 50 | $177.83 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $81.28 / $204.17
| Professional | | $25.70 | $81.28 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $234.42 / $489.78
| Professional | 50 | $120.23 | $234.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $93.33 / $263.03
| Professional | | $48.98 | $93.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $104.71 / $204.17
| Professional | | $27.54 | $104.71 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $158.49 / $1,148.15
| Facility | | $45.71 | $158.49 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $630.96
| Facility | 50 | $97.72 | $97.72 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $141.25 / $323.59
| Professional | | $69.18 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $162.18 / $239.88
| Professional | | $60.26 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $117.49 / $239.88
| Professional | | $23.99 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $52.48 / $165.96
| Professional | | $23.44 | $52.48 | $165.96 |
- 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
- $27.54 / $81.28 / $208.93
| Professional | | $27.54 | $81.28 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | 50 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $194.98
| Professional | | $51.29 | $60.26 | $194.98 |