- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $125.89 / $407.38
| Facility | | $30.20 | $125.89 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $758.58
| Facility | 50 | $208.93 | $245.47 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $69.18 / $144.54
| Professional | | $25.12 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $138.04 / $239.88
| Professional | 50 | $42.66 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $79.43 / $89.13
| Professional | | $28.84 | $79.43 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 50 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.60 / $38.02
| Professional | | $11.75 | $16.60 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $24.55 / $56.23
| Professional | 50 | $17.78 | $24.55 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $42.66
| Facility | | $25.12 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $91.20 / $109.65
| Professional | | $30.90 | $91.20 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $45.71
| Facility | | $34.67 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $93.33 / $416.87
| Professional | | $25.70 | $93.33 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $66.07
| Professional | | $24.55 | $33.11 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $724.44 / $1,949.84
| Facility | | $58.88 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $64.57 / $138.04
| Professional | | $28.18 | $64.57 | $138.04 |