- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $5,011.87
| Facility | | $70.79 | $131.83 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $562.34
| Facility | 50 | $234.42 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $70.79 / $173.78
| Professional | | $34.67 | $70.79 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $134.90 / $269.15
| Professional | 50 | $54.95 | $134.90 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $85.11 / $134.90
| Professional | | $50.12 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $138.04
| Professional | | $58.88 | $93.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $128.82
| Facility | | $44.67 | $74.13 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $562.34
| Facility | 50 | $234.42 | $234.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $134.90
| Professional | | $51.29 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $134.90 / $269.15
| Professional | 50 | $51.29 | $134.90 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $104.71
| Facility | | $61.66 | $95.50 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $112.20
| Facility | | $38.90 | $70.79 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $134.90
| Professional | | $63.10 | $85.11 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,174.90
| Facility | | $741.31 | $1,023.29 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $1,737.80
| Facility | 50 | $1,096.48 | $1,548.82 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $141.25
| Professional | | $66.07 | $97.72 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,318.26 / $5,128.61
| Facility | | $676.08 | $1,318.26 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $128.82
| Professional | | $52.48 | $81.28 | $128.82 |