- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $123.03 / $1,380.38
| Facility | | $46.77 | $123.03 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | 50 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $89.13 / $208.93
| Professional | | $44.67 | $89.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $128.82
| Professional | 50 | $67.61 | $114.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $89.13
| Professional | | $75.86 | $79.43 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | 50 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $85.11
| Professional | | $47.86 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $128.82
| Professional | 50 | $70.79 | $85.11 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $81.28
| Facility | | $42.66 | $61.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $102.33
| Professional | | $54.95 | $79.43 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $81.28 / $81.28
| Facility | | $34.67 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $512.86
| Professional | | $56.23 | $114.82 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $724.44 / $1,949.84
| Facility | | $58.88 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $151.36
| Professional | | $45.71 | $79.43 | $151.36 |