- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,621.81 / $3,467.37
| Facility | | $177.83 | $1,621.81 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 50 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $346.74 / $1,288.25
| Professional | | $169.82 | $346.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $1,288.25
| Professional | 50 | $79.43 | $128.82 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1,047.13 / $2,511.89
| Facility | | $1.00 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,023.29 / $2,570.40
| Professional | | $295.12 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $1,513.56 / $3,890.45
| Professional | 50 | $436.52 | $1,513.56 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,090.30 / $7,413.10
| Facility | | $2,137.96 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,380.38 / $3,467.37
| Professional | | $380.19 | $1,380.38 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,884.03 / $5,623.41
| Facility | | $2,344.23 | $2,884.03 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,348.96 / $3,090.30
| Professional | | $354.81 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,174.90 / $3,388.44
| Facility | | $251.19 | $1,174.90 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $190.55 / $758.58 / $7,585.78
| Facility | 50 | $190.55 | $758.58 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,737.80 / $3,801.89
| Professional | | $1,071.52 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,089.30 / $3,467.37
| Facility | | $1,584.89 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $891.25 / $2,884.03
| Professional | | $257.04 | $891.25 | $2,884.03 |