- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,230.27 / $7,079.46
| Facility | | $309.03 | $1,230.27 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $912.01 / $3,548.13 / $7,762.47
| Facility | 50 | $912.01 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $323.59 / $1,737.80
| Professional | | $194.98 | $323.59 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $288.40 / $912.01
| Professional | 50 | $47.86 | $288.40 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $323.59
| Professional | | $169.82 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $478.63
| Professional | 50 | $257.04 | $338.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $3,311.31 / $5,495.41
| Professional | | $181.97 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $630.96
| Professional | | $208.93 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $346.74 / $912.01
| Professional | | $147.91 | $346.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $707.95
| Professional | | $398.11 | $588.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $691.83
| Facility | | $199.53 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $457.09 / $8,709.64
| Facility | | $186.21 | $457.09 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $8,709.64
| Professional | | $288.40 | $501.19 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $6,165.95 / $12,882.50
| Facility | | $3,630.78 | $6,165.95 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $331.13 / $616.60
| Professional | | $165.96 | $331.13 | $616.60 |