- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $147.91 / $676.08
| Facility | | $45.71 | $147.91 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $776.25
| Facility | 50 | $194.98 | $229.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $63.10 / $138.04
| Professional | | $25.12 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.38 / $77.62 / $354.81
| Professional | 50 | $17.38 | $77.62 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $48.98 / $120.23
| Professional | | $43.65 | $48.98 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Professional | 50 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,737.80
| Facility | | $676.08 | $891.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $120.23
| Professional | | $29.51 | $57.54 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $186.21
| Professional | | $53.70 | $87.10 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $95.50 / $489.78
| Facility | | $31.62 | $95.50 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | 50 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $478.63
| Professional | | $64.57 | $114.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $120.23 / $181.97
| Professional | | $56.23 | $120.23 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $199.53
| Professional | | $50.12 | $83.18 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,047.13 / $3,801.89
| Facility | | $199.53 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $70.79 / $144.54
| Professional | | $33.88 | $70.79 | $144.54 |