- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $660.69 / $891.25
| Facility | | $281.84 | $660.69 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $575.44 / $1,548.82
| Facility | 50 | $89.13 | $575.44 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $107.15
| Professional | | $30.90 | $52.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $181.97
| Professional | 50 | $107.15 | $107.15 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $57.54
| Facility | | $34.67 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $109.65
| Professional | | $45.71 | $97.72 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $57.54
| Facility | | $34.67 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $245.47
| Professional | | $32.36 | $61.66 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $407.38 / $1,479.11
| Facility | | $245.47 | $407.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $562.34 / $794.33
| Facility | 50 | $489.78 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $72.44
| Professional | | $60.26 | $67.61 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $104.71
| Professional | 50 | $102.33 | $102.33 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $851.14
| Facility | | $457.09 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $77.62
| Professional | | $30.90 | $48.98 | $77.62 |