- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $186.21 / $316.23
| Facility | | $44.67 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | 50 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $91.20 / $269.15
| Professional | | $44.67 | $91.20 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $446.68 / $645.65
| Professional | 50 | $100.00 | $446.68 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $251.19 / $588.84
| Facility | | $131.83 | $251.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $1,380.38
| Facility | 50 | $302.00 | $489.78 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $288.40
| Professional | | $87.10 | $147.91 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $436.52
| Professional | 50 | $123.03 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $707.95
| Facility | | $213.80 | $302.00 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $338.84
| Professional | | $104.71 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $562.34
| Facility | | $229.09 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $323.59
| Professional | | $102.33 | $177.83 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $165.96 / $562.34
| Facility | | $70.79 | $165.96 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 50 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $173.78 / $446.68
| Professional | | $100.00 | $173.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,819.70 / $3,715.35
| Facility | | $346.74 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $141.25 / $269.15
| Professional | | $67.61 | $141.25 | $269.15 |