- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $537.03 / $5,623.41
| Facility | | $60.26 | $537.03 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $891.25 / $5,888.44
| Facility | 50 | $131.83 | $891.25 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $79.43 / $177.83
| Professional | | $43.65 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $281.84 / $630.96 / $954.99
| Professional | 22 | $281.84 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $275.42
| Professional | 50 | $69.18 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $89.13
| Professional | | $42.66 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $144.54
| Professional | 50 | $72.44 | $107.15 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $4,265.80 / $8,317.64
| Facility | | $575.44 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $70.79 / $134.90
| Professional | | $41.69 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $199.53
| Professional | 50 | $63.10 | $107.15 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $58.88
| Facility | | $41.69 | $51.29 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $85.11
| Professional | | $58.88 | $75.86 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $162.18
| Facility | | $50.12 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $123.03
| Professional | | $46.77 | $69.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,137.96 / $7,413.10
| Facility | | $257.04 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $109.65
| Professional | | $41.69 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | 50 | $79.43 | $79.43 | $85.11 |