- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $8,912.51
| Facility | | $75.86 | $134.90 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $3,890.45 / $3,890.45
| Facility | 50 | $416.87 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $114.82 / $263.03
| Professional | | $61.66 | $114.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $478.63
| Professional | 50 | $162.18 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $186.21
| Professional | | $97.72 | $123.03 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $158.49
| Professional | 50 | $151.36 | $151.36 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,412.54 / $3,467.37
| Facility | | $1,288.25 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $112.20 / $199.53
| Professional | | $50.12 | $112.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $295.12
| Professional | 50 | $93.33 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $138.04 / $257.04
| Professional | | $79.43 | $138.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $123.03 / $234.42
| Professional | | $61.66 | $123.03 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $125.89 / $245.47
| Professional | | $66.07 | $125.89 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $40.74 / $123.03
| Facility | | $39.81 | $40.74 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | 50 | $125.89 | $125.89 | $125.89 |