- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,754.23 / $5,623.41
| Facility | | $407.38 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,630.27 / $9,772.37 / $30,199.52
| Facility | 50 | $2,630.27 | $9,772.37 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $758.58 / $2,951.21
| Professional | | $288.40 | $758.58 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $676.08 / $5,011.87
| Professional | 50 | $407.38 | $676.08 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $251.19 / $1,230.27
| Professional | | $125.89 | $251.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $229.09 / $1,862.09
| Professional | 50 | $204.17 | $229.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $645.65 / $645.65
| Facility | | $74.13 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $2,137.96
| Professional | | $407.38 | $467.74 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $3,235.94
| Professional | 50 | $691.83 | $691.83 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $512.86
| Facility | | $269.15 | $371.54 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,621.81 / $1,949.84
| Professional | | $1,202.26 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,023.29 / $2,884.03
| Professional | | $316.23 | $1,023.29 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,884.03 / $6,309.57
| Facility | | $416.87 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,630.27 / $2,754.23 / $16,982.44
| Facility | 50 | $2,630.27 | $2,754.23 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,479.11 / $3,090.30
| Professional | | $316.23 | $1,479.11 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $676.08 / $3,162.28
| Professional | 50 | $389.05 | $676.08 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,071.52 / $2,344.23
| Professional | | $309.03 | $1,071.52 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,288.25 / $2,041.74
| Facility | | $467.74 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,412.54 / $2,691.53
| Professional | | $316.23 | $1,412.54 | $2,691.53 |