- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $724.44 / $5,495.41
| Facility | | $223.87 | $724.44 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $10,232.93
| Facility | 50 | $1,819.70 | $1,819.70 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $97.72 / $239.88
| Professional | | $41.69 | $97.72 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | 50 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $107.15 / $239.88
| Professional | | $41.69 | $107.15 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $177.83 / $1,318.26
| Facility | | $56.23 | $177.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $10,232.93
| Facility | 50 | $1,819.70 | $1,819.70 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $380.19
| Professional | | $83.18 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | 50 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $407.38
| Professional | | $169.82 | $302.00 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $123.03 / $302.00
| Facility | | $47.86 | $123.03 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $186.21
| Professional | | $60.26 | $85.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $177.83 / $478.63
| Professional | | $61.66 | $177.83 | $478.63 |