- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,454.71 / $8,511.38
| Facility | | $380.19 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $891.25 / $891.25
| Facility | 50 | $776.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $354.81 / $954.99
| Professional | | $109.65 | $354.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $575.44 / $616.60
| Professional | 50 | $239.88 | $575.44 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $93.33 / $512.86
| Professional | | $47.86 | $93.33 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $660.69
| Professional | 50 | $346.74 | $346.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $4,073.80 / $12,302.69
| Facility | | $354.81 | $4,073.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $426.58 / $588.84
| Professional | | $107.15 | $426.58 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $1,412.54
| Facility | | $114.82 | $181.97 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $389.05 / $977.24
| Professional | | $123.03 | $389.05 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $53.70 / $58.88
| Facility | | $51.29 | $53.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $371.54 / $691.83
| Professional | | $151.36 | $371.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $81.28 / $363.08
| Professional | | $32.36 | $81.28 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,412.54 / $3,630.78
| Facility | | $204.17 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $363.08 / $891.25
| Professional | | $107.15 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $190.55 / $524.81
| Professional | | $81.28 | $190.55 | $524.81 |