- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $1,318.26
| Facility | | $48.98 | $54.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $117.49
| Professional | | $47.86 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Professional | 50 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,023.29 / $2,238.72
| Facility | | $398.11 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $707.95 / $1,122.02 / $3,162.28
| Facility | 50 | $707.95 | $1,122.02 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $181.97
| Professional | | $72.44 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $269.15
| Professional | 50 | $109.65 | $162.18 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $457.09
| Facility | | $134.90 | $190.55 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $229.09
| Professional | | $87.10 | $144.54 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $354.81
| Facility | | $147.91 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $204.17
| Professional | | $85.11 | $128.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $562.34
| Facility | | $56.23 | $93.33 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $138.04 / $398.11
| Professional | | $64.57 | $138.04 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,819.70 / $3,715.35
| Facility | | $812.83 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $213.80
| Professional | | $66.07 | $120.23 | $213.80 |