- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $1,348.96 / $4,570.88
| Facility | | $77.62 | $1,348.96 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $1,778.28 / $5,248.07
| Facility | 50 | $416.87 | $1,778.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $81.28 / $213.80
| Professional | | $43.65 | $81.28 | $213.80 |
- 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
- $67.61 / $123.03 / $363.08
| Professional | 50 | $67.61 | $123.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $58.88 / $75.86
| Professional | | $36.31 | $58.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $109.65
| Professional | 50 | $72.44 | $89.13 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $109.65
| Professional | | $50.12 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $165.96
| Professional | 50 | $75.86 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $69.18 / $93.33
| Professional | | $41.69 | $69.18 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $123.03
| Professional | | $51.29 | $74.13 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $1,230.27
| Facility | | $45.71 | $91.20 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Facility | 50 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | 52 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $478.63
| Professional | | $61.66 | $95.50 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $77.62 / $87.10 / $128.82
| Professional | 50 | $77.62 | $87.10 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $549.54 / $1,698.24
| Facility | | $245.47 | $549.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $107.15
| Professional | | $45.71 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $134.90
| Professional | 50 | $85.11 | $85.11 | $134.90 |