- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $1,698.24 / $5,011.87
| Facility | | $60.26 | $1,698.24 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 50 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $295.12
| Professional | | $38.90 | $79.43 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $74.13 / $151.36 / $416.87
| Professional | 50 | $74.13 | $151.36 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $74.13
| Professional | | $48.98 | $57.54 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $123.03 / $128.82
| Professional | 50 | $67.61 | $123.03 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $97.72
| Professional | | $46.77 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $97.72
| Professional | 50 | $57.54 | $67.61 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $107.15
| Professional | | $40.74 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $48.98 / $79.43
| Professional | | $0.32 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.24 / $48.98 / $89.13
| Professional | | $0.24 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $60.26 / $281.84
| Professional | | $33.11 | $60.26 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $977.24 / $2,041.74
| Facility | | $31.62 | $977.24 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $93.33
| Professional | | $36.31 | $57.54 | $93.33 |