- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $158.49 / $524.81
| Facility | | $52.48 | $158.49 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $891.25
| Facility | 50 | $295.12 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $54.95 / $117.49
| Professional | | $25.12 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $107.15 / $234.42
| Professional | 50 | $52.48 | $107.15 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $165.96
| Professional | | $38.90 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $154.88
| Professional | | $45.71 | $66.07 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $131.83
| Facility | | $34.67 | $67.61 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $891.25
| Facility | 50 | $295.12 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $147.91
| Professional | | $42.66 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $102.33 / $354.81
| Professional | 50 | $52.48 | $102.33 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $117.49 / $123.03
| Facility | | $63.10 | $117.49 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $128.82
| Facility | | $34.67 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $158.49
| Professional | | $50.12 | $79.43 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $524.81 / $630.96
| Facility | | $380.19 | $524.81 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $794.33 / $933.25
| Facility | 50 | $562.34 | $794.33 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $87.10 / $173.78
| Professional | | $50.12 | $87.10 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $794.33 / $5,128.61
| Facility | | $489.78 | $794.33 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $151.36
| Professional | | $42.66 | $74.13 | $151.36 |