- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $41.69 / $549.54
| Facility | | $16.60 | $41.69 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 50 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $48.98
| Professional | | $15.85 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $79.43 / $102.33
| Professional | 50 | $47.86 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $44.67
| Professional | | $27.54 | $30.20 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $39.81
| Professional | 50 | $36.31 | $36.31 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $21.88 / $89.13
| Facility | | $13.18 | $21.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $22.91
| Professional | | $14.13 | $20.42 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $47.86
| Professional | | $27.54 | $38.02 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $97.72 / $97.72
| Facility | | $15.14 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $34.67 / $61.66
| Professional | | $19.05 | $34.67 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $1,288.25
| Facility | | $54.95 | $56.23 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $234.42 / $234.42
| Professional | | $213.80 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $64.57
| Facility | | $18.20 | $36.31 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 50 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $50.12
| Professional | | $16.98 | $28.18 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $74.13 / $91.20
| Professional | 50 | $47.86 | $74.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $25.70 / $33.11
| Professional | | $14.45 | $25.70 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $102.33
| Professional | | $30.20 | $56.23 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $61.66
| Facility | | $18.20 | $36.31 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $60.26
| Professional | | $19.05 | $33.88 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $851.14 / $2,290.87
| Facility | | $128.82 | $851.14 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $48.98
| Professional | | $16.60 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $28.18
| Professional | | $26.92 | $27.54 | $28.18 |