- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $281.84 / $7,413.10
| Facility | | $61.66 | $281.84 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 50 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $144.54
| Professional | | $44.67 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | 50 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $151.36
| Professional | | $58.88 | $58.88 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $229.09 / $239.88
| Facility | | $53.70 | $229.09 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $134.90
| Professional | | $69.18 | $69.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $85.11 / $181.97
| Professional | | $48.98 | $85.11 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $104.71 / $1,096.48
| Facility | | $54.95 | $104.71 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $645.65
| Professional | | $81.28 | $141.25 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $380.19 / $1,905.46
| Facility | | $100.00 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $141.25
| Professional | | $53.70 | $81.28 | $141.25 |