- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $64.57 / $691.83
| Facility | | $25.12 | $64.57 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | 50 | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $53.70 / $114.82
| Professional | | $25.12 | $53.70 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $354.81
| Professional | 50 | $91.20 | $120.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $537.03 / $1,174.90
| Facility | | $208.93 | $537.03 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $588.84 / $1,698.24
| Facility | 50 | $371.54 | $588.84 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $223.87
| Professional | | $46.77 | $95.50 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $144.54 / $338.84
| Professional | 50 | $70.79 | $144.54 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $575.44
| Facility | | $169.82 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $269.15
| Professional | | $56.23 | $114.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $223.87 / $446.68
| Facility | | $181.97 | $223.87 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $102.33 / $218.78
| Professional | | $54.95 | $102.33 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $69.18 / $380.19
| Facility | | $32.36 | $69.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $112.20 / $302.00
| Professional | | $58.88 | $112.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $398.11
| Professional | 50 | $234.42 | $234.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,778.28 / $3,715.35
| Facility | | $416.87 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $75.86 / $190.55
| Professional | | $37.15 | $75.86 | $190.55 |