- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $186.21 / $7,943.28
| Facility | | $56.23 | $186.21 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $630.96 / $5,011.87
| Facility | 50 | $38.90 | $630.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $57.54 / $138.04
| Professional | | $30.20 | $57.54 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $134.90 / $275.42
| Professional | 50 | $66.07 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Professional | 52 | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $93.33
| Professional | | $34.67 | $72.44 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $165.96
| Professional | 50 | $48.98 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | 52 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $891.25
| Facility | | $354.81 | $457.09 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $91.20
| Professional | | $37.15 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $134.90
| Professional | | $45.71 | $91.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $1,230.27
| Facility | | $43.65 | $75.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $199.53
| Facility | 50 | $93.33 | $117.49 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | 52 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $354.81
| Professional | | $63.10 | $95.50 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $104.71 / $134.90
| Professional | | $69.18 | $104.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $107.15
| Professional | | $70.79 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $85.11 / $123.03
| Professional | | $3.98 | $85.11 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $1,047.13 / $3,801.89
| Facility | | $72.44 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $112.20
| Professional | | $43.65 | $70.79 | $112.20 |