- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $169.82 / $537.03
| Facility | | $35.48 | $169.82 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $549.54 / $691.83
| Facility | 50 | $165.96 | $549.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $67.61 / $141.25
| Professional | | $25.12 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $138.04 / $354.81
| Professional | 50 | $42.66 | $138.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $70.79 / $102.33
| Professional | | $22.91 | $70.79 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | 50 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $138.04
| Professional | | $35.48 | $58.88 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $208.93
| Professional | 50 | $63.10 | $63.10 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $54.95
| Facility | | $30.20 | $39.81 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $181.97
| Professional | | $75.86 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $63.10 / $120.23
| Professional | | $19.05 | $63.10 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $169.82 / $524.81
| Facility | | $35.48 | $169.82 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $549.54 / $691.83
| Facility | 50 | $218.78 | $549.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $79.43 / $144.54
| Professional | | $27.54 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $138.04 / $354.81
| Professional | 50 | $42.66 | $138.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $63.10 / $117.49
| Professional | | $17.38 | $63.10 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $524.81 / $1,698.24
| Facility | | $128.82 | $524.81 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $60.26 / $112.20
| Professional | | $16.22 | $60.26 | $112.20 |