- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $512.86 / $1,412.54
| Facility | | $138.04 | $512.86 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $707.95 / $1,949.84 / $2,187.76
| Facility | 50 | $707.95 | $1,949.84 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $389.05
| Professional | | $48.98 | $112.20 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $74.13 / $204.17 / $741.31
| Professional | 50 | $74.13 | $204.17 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $371.54 / $1,096.48
| Facility | | $181.97 | $371.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $269.15 / $562.34 / $1,659.59
| Facility | 50 | $269.15 | $562.34 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $181.97
| Professional | | $87.10 | $134.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $269.15
| Professional | 50 | $131.83 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $28.84
| Professional | 80 | $15.14 | $21.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $151.36
| Professional | | $58.88 | $93.33 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $125.89 / $512.86
| Facility | | $53.70 | $125.89 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $1,318.26 / $2,187.76
| Facility | 50 | $691.83 | $1,318.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $223.87
| Professional | | $72.44 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $74.13 / $177.83 / $741.31
| Professional | 50 | $74.13 | $177.83 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $186.21
| Professional | | $85.11 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $91.20 / $190.55
| Professional | | $79.43 | $91.20 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $162.18
| Professional | | $56.23 | $95.50 | $162.18 |