- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $436.52 / $4,786.30
| Facility | | $173.78 | $436.52 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $1,096.48 / $7,585.78
| Facility | 50 | $363.08 | $1,096.48 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $138.04 / $338.84
| Professional | | $54.95 | $138.04 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $537.03
| Professional | 50 | $128.82 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $251.19
| Professional | | $77.62 | $147.91 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $213.80
| Professional | | $147.91 | $165.96 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $239.88
| Professional | | $131.83 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $363.08
| Professional | 50 | $199.53 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $117.49 / $251.19
| Professional | | $60.26 | $117.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $281.84
| Professional | | $275.42 | $275.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $165.96 / $275.42
| Professional | | $66.07 | $165.96 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $812.83
| Facility | | $218.78 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $5,128.61
| Facility | 50 | $275.42 | $363.08 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $57.54
| Professional | | $48.98 | $48.98 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $190.55
| Professional | | $165.96 | $165.96 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $794.33 / $5,754.40
| Facility | | $74.13 | $794.33 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 50 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $120.23 / $316.23
| Professional | | $56.23 | $120.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $316.23
| Professional | | $141.25 | $173.78 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $151.36
| Facility | | $56.23 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $165.96
| Professional | | $53.70 | $75.86 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $467.74 / $3,890.45
| Facility | | $213.80 | $467.74 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $102.33 / $204.17
| Professional | | $52.48 | $102.33 | $204.17 |