- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $199.53 / $389.05
| Facility | | $31.62 | $199.53 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $263.03 / $562.34 / $758.58
| Facility | 50 | $263.03 | $562.34 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $61.66 / $120.23
| Professional | | $25.12 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $100.00 / $354.81
| Professional | 50 | $33.11 | $100.00 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $64.57
| Professional | | $24.55 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $97.72
| Professional | 50 | $38.02 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $1,047.13
| Professional | | $22.91 | $33.11 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $70.79 / $158.49
| Professional | | $23.99 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $125.89
| Professional | | $83.18 | $104.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $208.93
| Professional | | $112.20 | $138.04 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $64.57 / $141.25
| Facility | | $25.70 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $38.02 / $1,288.25
| Facility | | $15.49 | $38.02 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $1,288.25
| Professional | | $67.61 | $109.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,023.29 / $2,344.23
| Facility | | $204.17 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $63.10 / $154.88
| Professional | | $23.44 | $63.10 | $154.88 |