- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $218.78 / $467.74
| Facility | | $41.69 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $380.19 / $933.25
| Facility | 50 | $199.53 | $380.19 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $77.62 / $169.82
| Professional | | $25.12 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $138.04 / $316.23
| Professional | 50 | $42.66 | $138.04 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $131.83
| Professional | | $75.86 | $120.23 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $72.44 / $74.13
| Facility | | $26.92 | $72.44 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $109.65 / $208.93
| Professional | | $31.62 | $109.65 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $602.56
| Facility | | $117.49 | $117.49 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $83.18 / $165.96
| Professional | | $29.51 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $208.93
| Professional | | $138.04 | $138.04 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $70.79 / $138.04
| Facility | | $26.92 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $125.89 / $162.18
| Professional | | $42.66 | $125.89 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $724.44 / $1,949.84
| Facility | | $125.89 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $60.26 / $134.90
| Professional | | $22.39 | $60.26 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $354.81 / $354.81
| Facility | | $56.23 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $724.44
| Professional | | $630.96 | $630.96 | $724.44 |