- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $5,011.87
| Facility | | $66.07 | $112.20 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $199.53 / $4,265.80
| Facility | 50 | $53.70 | $199.53 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Facility | 52 | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $64.57 / $181.97
| Professional | | $29.51 | $64.57 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $138.04 / $302.00
| Professional | 50 | $53.70 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Professional | 52 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $83.18 / $128.82
| Professional | | $45.71 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $114.82
| Professional | | $51.29 | $79.43 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $151.36
| Facility | | $42.66 | $69.18 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $354.81 / $4,265.80
| Facility | 50 | $53.70 | $354.81 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $128.82
| Professional | | $42.66 | $79.43 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $134.90 / $302.00
| Professional | 50 | $47.86 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Professional | 52 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $95.50
| Facility | | $58.88 | $91.20 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $114.82
| Facility | | $40.74 | $66.07 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $123.03
| Professional | | $58.88 | $81.28 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $257.04
| Facility | | $154.88 | $213.80 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | 50 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $131.83
| Professional | | $63.10 | $91.20 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $676.08 / $5,128.61
| Facility | | $177.83 | $676.08 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $125.89
| Professional | | $48.98 | $81.28 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $112.20
| Professional | 50 | $79.43 | $79.43 | $112.20 |