- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $181.97 / $3,235.94
| Facility | | $66.07 | $181.97 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $1,862.09
| Facility | 50 | $354.81 | $398.11 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $87.10 / $165.96
| Professional | | $47.86 | $87.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $251.19 / $251.19
| Professional | 50 | $128.82 | $251.19 | $251.19 |
- 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
- $44.67 / $60.26 / $85.11
| Professional | | $44.67 | $60.26 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $128.82
| Professional | 50 | $67.61 | $89.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $1,047.13
| Professional | | $54.95 | $75.86 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $173.78
| Professional | | $53.70 | $89.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $102.33 / $257.04
| Professional | | $40.74 | $102.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $194.98
| Professional | | $147.91 | $186.21 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $91.20 / $186.21
| Facility | | $51.29 | $91.20 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $1,659.59
| Facility | | $45.71 | $70.79 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $1,659.59
| Professional | | $77.62 | $144.54 | $1,659.59 |
- 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
- $43.65 / $83.18 / $165.96
| Professional | | $43.65 | $83.18 | $165.96 |