- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $1,318.26 / $2,398.83
| Facility | | $117.49 | $1,318.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,202.26
| Facility | 50 | $707.95 | $707.95 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $112.20 / $295.12
| Professional | | $50.12 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $660.69
| Professional | 50 | $147.91 | $251.19 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $645.65 / $1,778.28
| Facility | | $123.03 | $645.65 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $1,000.00 / $2,691.53
| Facility | 50 | $295.12 | $1,000.00 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $147.91
| Professional | | $70.79 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $223.87
| Professional | 50 | $114.82 | $186.21 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $134.90
| Professional | | $48.98 | $81.28 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $123.03 / $1,023.29
| Facility | | $50.12 | $123.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,202.26
| Facility | 50 | $707.95 | $707.95 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $190.55
| Professional | | $63.10 | $107.15 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $363.08
| Professional | 50 | $169.82 | $169.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,548.82 / $2,238.72
| Facility | | $1,230.27 | $1,548.82 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $2,630.27 / $3,388.44
| Facility | 50 | $1,862.09 | $2,630.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $154.88
| Professional | | $70.79 | $104.71 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $467.74
| Professional | | $64.57 | $81.28 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,630.27 / $4,466.84
| Facility | | $446.68 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $154.88
| Professional | | $58.88 | $97.72 | $154.88 |