- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $107.15 / $4,897.79
| Facility | | $33.11 | $107.15 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $588.84
| Facility | 50 | $524.81 | $524.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $95.50
| Professional | | $18.20 | $30.90 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.18 / $60.26 / $263.03
| Professional | 50 | $28.18 | $60.26 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $38.90
| Professional | | $23.44 | $35.48 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $41.69
| Professional | 50 | $35.48 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $40.74 / $75.86
| Professional | | $15.85 | $40.74 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $138.04 / $4,897.79
| Facility | | $33.11 | $138.04 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $588.84
| Facility | 50 | $524.81 | $524.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $79.43
| Professional | | $20.42 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $263.03
| Professional | 50 | $28.18 | $44.67 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $34.67 / $58.88
| Professional | | $15.85 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $426.58 / $1,698.24
| Facility | | $104.71 | $426.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $54.95 / $72.44
| Professional | | $24.55 | $54.95 | $72.44 |