- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $218.78 / $3,090.30
| Facility | | $33.88 | $218.78 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $2,951.21
| Facility | 50 | $645.65 | $645.65 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $186.21
| Professional | | $34.67 | $63.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $114.82 / $389.05
| Professional | 50 | $50.12 | $114.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,548.82
| Facility | | $398.11 | $707.95 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $3,162.28
| Facility | 50 | $691.83 | $1,096.48 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $194.98
| Professional | | $64.57 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $288.40
| Professional | 50 | $97.72 | $165.96 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $199.53 / $478.63
| Facility | | $141.25 | $199.53 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $229.09
| Professional | | $74.13 | $125.89 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $371.54
| Facility | | $154.88 | $190.55 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $213.80
| Professional | | $75.86 | $117.49 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $91.20 / $758.58
| Facility | | $42.66 | $91.20 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.72 / $1,023.29 / $3,090.30
| Facility | 50 | $0.72 | $1,023.29 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $131.83 / $263.03
| Professional | | $58.88 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $398.11
| Professional | 50 | $144.54 | $213.80 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,778.28 / $3,715.35
| Facility | | $776.25 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $89.13 / $181.97
| Professional | | $44.67 | $89.13 | $181.97 |