- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $501.19 / $4,897.79
| Facility | | $74.13 | $501.19 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $1,584.89 / $5,011.87
| Facility | 50 | $323.59 | $1,584.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $97.72 / $218.78
| Professional | | $52.48 | $97.72 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $177.83 / $660.69
| Professional | 50 | $104.71 | $177.83 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $77.62 / $117.49
| Professional | 50 | $75.86 | $77.62 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $117.49 / $120.23
| Professional | | $48.98 | $117.49 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $181.97
| Professional | 50 | $125.89 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $112.20
| Facility | | $60.26 | $74.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $169.82
| Professional | | $67.61 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $85.11 / $138.04
| Professional | | $51.29 | $85.11 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $380.19 / $4,897.79
| Facility | | $74.13 | $380.19 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $1,949.84
| Facility | 50 | $323.59 | $660.69 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $186.21
| Professional | | $66.07 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $616.60
| Professional | 50 | $100.00 | $177.83 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $79.43 / $134.90
| Professional | | $47.86 | $79.43 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $812.83 / $1,698.24
| Facility | | $245.47 | $812.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $128.82
| Professional | | $56.23 | $85.11 | $128.82 |