- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $2,041.74 / $8,317.64
| Facility | | $61.66 | $2,041.74 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $181.97
| Professional | | $47.86 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | 50 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $91.20
| Professional | | $43.65 | $63.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $138.04
| Professional | 50 | $64.57 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $1,047.13
| Professional | | $45.71 | $69.18 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $128.82
| Professional | | $45.71 | $75.86 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $75.86
| Professional | | $38.02 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $79.43
| Professional | | $75.86 | $75.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $123.03
| Facility | | $48.98 | $75.86 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $102.33 / $4,073.80
| Facility | | $41.69 | $102.33 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $109.65 / $4,073.80
| Professional | | $51.29 | $109.65 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,344.23
| Facility | | $204.17 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $125.89
| Professional | | $42.66 | $63.10 | $125.89 |