- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $194.98 / $616.60
| Facility | | $44.67 | $194.98 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $416.87 / $870.96
| Facility | 50 | $199.53 | $416.87 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $52.48 / $109.65
| Professional | | $25.70 | $52.48 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $213.80
| Professional | 50 | $52.48 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $61.66 / $102.33
| Professional | | $53.70 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.88 / $89.13 / $125.89
| Professional | 50 | $33.88 | $89.13 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $1,445.44 / $9,772.37
| Facility | | $40.74 | $1,445.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $67.61
| Professional | | $25.12 | $50.12 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $48.98
| Facility | | $41.69 | $42.66 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $56.23 / $104.71
| Professional | | $27.54 | $56.23 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,041.74 / $3,388.44
| Facility | | $1,412.54 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $64.57
| Professional | | $27.54 | $47.86 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $81.28
| Professional | | $19.95 | $33.11 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,445.44 / $3,630.78
| Facility | | $194.98 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $45.71 / $91.20
| Professional | | $25.12 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $47.86 / $66.07
| Professional | | $19.95 | $47.86 | $66.07 |