- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,949.84 / $3,630.78
| Facility | | $151.36 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $4,265.80 / $5,754.40
| Facility | 50 | $1,288.25 | $4,265.80 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $177.83 / $446.68
| Professional | | $87.10 | $177.83 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $302.00 / $1,584.89
| Professional | 50 | $128.82 | $302.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,238.72 / $6,606.93
| Facility | | $1,202.26 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $3,388.44 / $9,549.93
| Facility | 50 | $2,089.30 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $323.59 / $645.65
| Professional | | $165.96 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $954.99
| Professional | 50 | $245.47 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $676.08 / $1,584.89
| Facility | | $478.63 | $676.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $380.19 / $758.58
| Professional | | $199.53 | $380.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $1,258.93
| Facility | | $512.86 | $630.96 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $616.60
| Professional | | $199.53 | $363.08 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $295.12 / $2,290.87
| Facility | | $120.23 | $295.12 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $2,570.40 / $4,365.16
| Facility | 50 | $891.25 | $2,570.40 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $831.76
| Professional | | $177.83 | $346.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Professional | 50 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,290.87 / $5,370.32
| Facility | | $1,174.90 | $2,290.87 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $245.47 / $537.03
| Professional | | $117.49 | $245.47 | $537.03 |