- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $2,344.23 / $7,079.46
| Facility | | $77.62 | $2,344.23 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 50 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $158.49
| Professional | | $42.66 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $275.42
| Professional | 50 | $72.44 | $131.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $109.65
| Professional | | $57.54 | $74.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $177.83
| Professional | 50 | $72.44 | $112.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,089.30 / $3,981.07
| Facility | | $741.31 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $112.20
| Professional | | $44.67 | $75.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $165.96
| Professional | 50 | $67.61 | $114.82 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $54.95 / $75.86
| Facility | | $45.71 | $54.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $79.43
| Professional | | $52.48 | $67.61 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $645.65
| Facility | | $39.81 | $39.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $125.89
| Professional | | $46.77 | $72.44 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $123.03
| Professional | | $38.02 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $67.61 / $109.65
| Professional | | $56.23 | $67.61 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $112.20
| Professional | | $39.81 | $63.10 | $112.20 |