- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $1,412.54 / $5,495.41
| Facility | | $131.83 | $1,412.54 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $134.90 / $309.03
| Professional | | $67.61 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | 50 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $851.14 / $1,819.70
| Facility | | $223.87 | $851.14 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $1,258.93 / $2,691.53
| Facility | 50 | $562.34 | $1,258.93 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $208.93 / $309.03
| Professional | | $120.23 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $186.21 / $380.19 / $467.74
| Professional | 50 | $186.21 | $380.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $154.88
| Facility | | $123.03 | $123.03 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $229.09
| Professional | | $75.86 | $131.83 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $162.18 / $331.13
| Facility | | $69.18 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $346.74
| Professional | | $107.15 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | 50 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,737.80 / $2,238.72
| Facility | | $1,258.93 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $2,630.27 / $3,388.44
| Facility | 50 | $1,862.09 | $2,630.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $316.23
| Professional | | $112.20 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $660.69
| Professional | | $112.20 | $162.18 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,630.27 / $4,466.84
| Facility | | $446.68 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $134.90 / $239.88
| Professional | | $74.13 | $134.90 | $239.88 |