- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $186.21 / $436.52
| Facility | | $31.62 | $186.21 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $44.67 / $295.12 / $389.05
| Facility | 50 | $44.67 | $295.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $77.62 / $147.91
| Professional | | $25.70 | $77.62 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $234.42 / $512.86
| Professional | 50 | $120.23 | $234.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $89.13
| Professional | | $28.18 | $30.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $46.77
| Professional | 50 | $42.66 | $42.66 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,445.44 / $1,995.26
| Facility | | $616.60 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $56.23 / $151.36
| Professional | | $20.42 | $56.23 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $72.44 / $147.91
| Professional | | $25.70 | $72.44 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $354.81 / $354.81
| Facility | | $54.95 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $724.44 / $724.44
| Professional | | $630.96 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $812.83 / $2,344.23
| Facility | | $229.09 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $66.07 / $147.91
| Professional | | $21.88 | $66.07 | $147.91 |