- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $169.82 / $724.44
| Facility | | $34.67 | $169.82 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $1,000.00
| Facility | 50 | $363.08 | $851.14 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $85.11 / $173.78
| Professional | | $26.92 | $85.11 | $173.78 |
- 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
- $72.44 / $83.18 / $93.33
| Professional | | $72.44 | $83.18 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $851.14
| Facility | | $302.00 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $630.96 / $1,288.25
| Facility | 50 | $457.09 | $630.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $87.10 / $218.78
| Professional | | $39.81 | $87.10 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $707.95 / $870.96
| Facility | | $154.88 | $707.95 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $83.18 / $234.42
| Professional | | $33.11 | $83.18 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $77.62 / $218.78
| Facility | | $16.60 | $77.62 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $281.84 / $630.96 / $1,148.15
| Facility | 50 | $281.84 | $630.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $74.13 / $194.98
| Professional | | $16.98 | $74.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $57.54
| Professional | | $22.91 | $33.11 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $173.78
| Facility | | $102.33 | $169.82 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $120.23 / $213.80
| Professional | | $36.31 | $120.23 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $851.14
| Facility | | $288.40 | $436.52 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $660.69 / $1,288.25
| Facility | 50 | $436.52 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $87.10 / $213.80
| Professional | | $38.90 | $87.10 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $575.44 / $1,288.25
| Facility | | $151.36 | $575.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $79.43 / $199.53
| Professional | | $24.55 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $46.77 / $123.03
| Professional | | $24.55 | $46.77 | $123.03 |