- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $660.69 / $3,548.13
| Facility | | $269.15 | $660.69 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $3,162.28 / $4,073.80
| Facility | 50 | $575.44 | $3,162.28 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $1,122.02
| Professional | | $263.03 | $323.59 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $467.74 / $2,187.76
| Professional | 50 | $218.78 | $467.74 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $12,882.50 / $31,622.78
| Facility | | $1,584.89 | $12,882.50 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $16,218.10 / $26,302.68 / $74,131.02
| Facility | 50 | $16,218.10 | $26,302.68 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $977.24
| Professional | | $416.87 | $616.60 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $933.25 / $1,445.44
| Professional | 50 | $602.56 | $933.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $954.99 / $2,238.72
| Facility | | $660.69 | $954.99 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $812.83 / $1,202.26
| Professional | | $512.86 | $812.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,778.28
| Facility | | $724.44 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,023.29
| Professional | | $446.68 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $794.33 / $8,317.64
| Facility | | $354.81 | $794.33 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.55 / $2,398.83 / $4,677.35
| Facility | 50 | $0.55 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $1,479.11
| Professional | | $338.84 | $575.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $18,197.01
| Facility | | $3,019.95 | $5,248.07 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $588.84 / $1,071.52
| Professional | | $323.59 | $588.84 | $1,071.52 |