- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $1,047.13 / $2,818.38
| Facility | | $39.81 | $1,047.13 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 50 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $91.20 / $346.74
| Professional | | $41.69 | $91.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $47.86 / $128.82 / $389.05
| Professional | 50 | $47.86 | $128.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $2,344.23 / $4,897.79
| Facility | | $933.25 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,621.81 / $2,630.27 / $7,413.10
| Facility | 50 | $1,621.81 | $2,630.27 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $141.25 / $269.15
| Professional | | $74.13 | $141.25 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $213.80 / $398.11
| Professional | 50 | $112.20 | $213.80 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $676.08
| Facility | | $199.53 | $281.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $316.23
| Professional | | $91.20 | $165.96 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $524.81
| Facility | | $213.80 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $281.84
| Professional | | $89.13 | $162.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $158.49 / $1,513.56
| Facility | | $61.66 | $158.49 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $1,148.15 / $3,467.37
| Facility | 50 | $117.49 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $724.44
| Professional | | $83.18 | $169.82 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $1,122.02
| Professional | 50 | $131.83 | $239.88 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,238.72 / $5,370.32
| Facility | | $1,174.90 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $112.20 / $234.42
| Professional | | $56.23 | $112.20 | $234.42 |