- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $173.78 / $407.38
| Facility | | $12.02 | $173.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $562.34 / $812.83
| Facility | 50 | $51.29 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $67.61 / $134.90
| Professional | | $25.12 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $120.23 / $354.81
| Professional | 50 | $38.02 | $120.23 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $331.13 / $2,818.38
| Facility | | $56.23 | $331.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $81.28 / $257.04
| Professional | | $28.18 | $81.28 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $70.79
| Facility | | $30.20 | $30.20 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $91.20 / $186.21
| Professional | | $30.20 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $83.18 / $213.80
| Professional | | $28.84 | $83.18 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $3,311.31
| Facility | | $23.44 | $33.11 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $151.36
| Professional | | $95.50 | $117.49 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $85.11 / $213.80
| Professional | | $27.54 | $85.11 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $467.74
| Facility | | $147.91 | $177.83 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $331.13 / $2,818.38
| Facility | | $56.23 | $331.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $81.28 / $257.04
| Professional | | $28.18 | $81.28 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $562.34
| Facility | | $234.42 | $302.00 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,698.24 / $2,818.38
| Facility | | $426.58 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $85.11 / $223.87
| Professional | | $30.20 | $85.11 | $223.87 |