- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $316.23 / $2,818.38
| Facility | | $58.88 | $316.23 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $512.86 / $512.86
| Facility | 50 | $467.74 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $75.86 / $218.78
| Professional | | $37.15 | $75.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $151.36 / $446.68
| Professional | 50 | $81.28 | $151.36 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $302.00 / $758.58
| Facility | | $125.89 | $302.00 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $446.68 / $1,148.15
| Facility | 50 | $204.17 | $446.68 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $109.65
| Professional | | $63.10 | $79.43 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $141.25 / $165.96
| Professional | 50 | $91.20 | $141.25 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Facility | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $89.13
| Professional | | $41.69 | $60.26 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $79.43 / $331.13
| Facility | | $41.69 | $79.43 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | 50 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $138.04
| Professional | | $50.12 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $154.88 / $407.38
| Professional | 50 | $81.28 | $154.88 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $954.99
| Facility | | $537.03 | $660.69 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $1,096.48 / $1,412.54
| Facility | 50 | $794.33 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $112.20
| Professional | | $61.66 | $77.62 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $281.84
| Professional | | $48.98 | $61.66 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $104.71
| Professional | | $40.74 | $64.57 | $104.71 |