- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $151.36 / $331.13
| Facility | | $26.92 | $151.36 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $218.78 / $218.78
| Facility | 50 | $125.89 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $79.43 / $169.82
| Professional | | $25.12 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $691.83
| Professional | 50 | $120.23 | $138.04 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $537.03 / $1,174.90
| Facility | | $208.93 | $537.03 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $588.84 / $1,698.24
| Facility | 50 | $371.54 | $588.84 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $117.49 / $309.03
| Professional | | $47.86 | $117.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $169.82 / $467.74
| Professional | 50 | $70.79 | $169.82 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $812.83
| Facility | | $239.88 | $338.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $138.04 / $380.19
| Professional | | $58.88 | $138.04 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $630.96
| Facility | | $257.04 | $316.23 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $125.89 / $309.03
| Professional | | $58.88 | $125.89 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $151.36 / $501.19
| Facility | | $31.62 | $151.36 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $446.68 / $1,047.13
| Facility | 50 | $199.53 | $446.68 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $436.52
| Professional | | $83.18 | $154.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $446.68 / $457.09
| Professional | 50 | $426.58 | $446.68 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,778.28 / $3,715.35
| Facility | | $416.87 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $89.13 / $269.15
| Professional | | $25.12 | $89.13 | $269.15 |