- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $3,090.30 / $13,489.63
| Facility | | $524.81 | $3,090.30 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $6,456.54
| Facility | 50 | $1,698.24 | $1,698.24 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $524.81
| Professional | | $48.98 | $109.65 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $436.52
| Professional | 50 | $72.44 | $123.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $95.50 / $120.23
| Professional | | $48.98 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $169.82
| Professional | 50 | $144.54 | $154.88 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,466.84 / $12,882.50
| Facility | | $2,570.40 | $4,466.84 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $218.78
| Professional | | $60.26 | $89.13 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $416.87
| Professional | 50 | $75.86 | $112.20 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $3,162.28 / $6,760.83
| Facility | | $85.11 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $134.90 / $275.42
| Professional | | $66.07 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $223.87
| Professional | | $58.88 | $107.15 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $131.83 / $199.53
| Professional | | $48.98 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $120.23 / $234.42
| Professional | | $44.67 | $120.23 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $19,498.45
| Facility | | $1,995.26 | $1,995.26 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 53 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Professional | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $154.88
| Professional | | $93.33 | $93.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $109.65 / $218.78
| Facility | | $52.48 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $239.88
| Professional | | $58.88 | $109.65 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $346.74
| Professional | | $169.82 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $169.82 / $251.19
| Professional | | $44.67 | $169.82 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,513.56 / $6,456.54
| Facility | | $588.84 | $1,513.56 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $204.17
| Professional | | $45.71 | $91.20 | $204.17 |