- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $2,884.03 / $6,456.54
| Facility | | $177.83 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $812.83 / $4,365.16 / $6,606.93
| Facility | 50 | $812.83 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $660.69
| Professional | | $87.10 | $194.98 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $295.12 / $1,023.29
| Professional | 50 | $123.03 | $295.12 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $165.96 / $407.38
| Professional | | $77.62 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $416.87
| Professional | 50 | $134.90 | $245.47 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,454.71 / $4,897.79
| Facility | | $1,778.28 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,630.27 / $3,630.78 / $7,413.10
| Facility | 50 | $2,630.27 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $426.58
| Professional | | $134.90 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $870.96 / $1,348.96
| Facility | | $501.19 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $478.63
| Professional | | $107.15 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $831.76
| Facility | | $112.20 | $223.87 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,905.46 / $3,235.94 / $6,760.83
| Facility | 50 | $1,905.46 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $512.86
| Professional | | $112.20 | $223.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $79.43
| Professional | | $32.36 | $33.11 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $346.74
| Facility | | $199.53 | $331.13 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $245.47 / $309.03
| Facility | | $234.42 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $245.47 / $436.52
| Professional | | $123.03 | $245.47 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,511.89 / $4,897.79
| Facility | | $1,659.59 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,511.89 / $3,801.89 / $7,413.10
| Facility | 50 | $2,511.89 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $426.58
| Professional | | $134.90 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,754.23 / $5,011.87
| Facility | | $812.83 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $398.11
| Professional | | $109.65 | $213.80 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 50 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $275.42
| Professional | | $89.13 | $169.82 | $275.42 |