- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $213.80 / $1,071.52
| Facility | | $83.18 | $213.80 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $371.54 / $2,344.23
| Facility | 50 | $316.23 | $371.54 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $154.88 / $363.08
| Professional | | $56.23 | $154.88 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $309.03 / $562.34
| Professional | 50 | $181.97 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $169.82
| Professional | | $70.79 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | 50 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $154.88 / $309.03
| Professional | | $75.86 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $288.40
| Professional | | $72.44 | $131.83 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $134.90 / $229.09
| Facility | | $56.23 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $371.54
| Professional | | $75.86 | $75.86 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $776.25 / $1,949.84
| Facility | | $173.78 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $107.15 / $223.87
| Professional | | $57.54 | $107.15 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,318.26
| Professional | | $1,122.02 | $1,122.02 | $1,318.26 |