- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $1,258.93 / $5,128.61
| Facility | | $69.18 | $1,258.93 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $3,388.44 / $6,456.54
| Facility | 50 | $467.74 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $204.17
| Professional | | $41.69 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $57.54 / $134.90 / $288.40
| Professional | 50 | $57.54 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $70.79
| Professional | | $26.30 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Professional | 50 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $120.23
| Professional | | $46.77 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $181.97
| Professional | 50 | $70.79 | $109.65 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $91.20
| Professional | | $75.86 | $75.86 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $50.12 / $66.07
| Facility | | $39.81 | $50.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $158.49
| Professional | | $70.79 | $91.20 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $144.54
| Professional | | $46.77 | $83.18 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,445.44 / $5,128.61
| Facility | | $154.88 | $1,445.44 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $79.43 / $144.54
| Professional | | $36.31 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $33.11
| Professional | | $26.92 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $436.52
| Facility | | $100.00 | $100.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $120.23
| Professional | | $38.90 | $79.43 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,737.80 / $4,073.80
| Facility | | $537.03 | $1,737.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $128.82
| Professional | | $38.90 | $74.13 | $128.82 |