- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,388.44 / $9,549.93
| Facility | | $575.44 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,412.54 / $5,370.32 / $5,888.44
| Facility | 50 | $1,412.54 | $5,370.32 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $691.83 / $1,949.84
| Professional | | $251.19 | $691.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Professional | 50 | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $251.19 / $363.08
| Professional | | $109.65 | $251.19 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | 50 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $478.63 / $1,905.46
| Professional | | $263.03 | $478.63 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $724.44 / $2,884.03
| Professional | 50 | $398.11 | $724.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $21,379.62
| Facility | | $204.17 | $346.74 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $676.08 / $1,698.24
| Professional | | $275.42 | $676.08 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $21,379.62
| Facility | | $426.58 | $426.58 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $645.65 / $1,584.89
| Professional | | $263.03 | $645.65 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $776.25 / $1,737.80
| Professional | | $229.09 | $776.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,023.29 / $3,235.94
| Facility | | $263.03 | $1,023.29 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $645.65 / $1,659.59
| Professional | | $263.03 | $645.65 | $1,659.59 |