- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $630.96 / $1,659.59
| Facility | | $81.28 | $630.96 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $1,819.70 / $2,570.40
| Facility | 50 | $645.65 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $100.00 / $346.74
| Professional | | $48.98 | $100.00 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $151.36 / $457.09
| Professional | 50 | $72.44 | $151.36 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $147.91
| Professional | | $70.79 | $85.11 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $223.87
| Professional | 50 | $97.72 | $125.89 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $204.17
| Facility | | $199.53 | $199.53 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $223.87
| Professional | | $74.13 | $147.91 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $181.97
| Professional | | $60.26 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $213.80
| Professional | | $138.04 | $138.04 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $147.91
| Facility | | $50.12 | $89.13 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $2,691.53
| Facility | | $1,778.28 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $181.97
| Professional | | $72.44 | $134.90 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $794.33 / $1,995.26
| Facility | | $208.93 | $794.33 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $162.18
| Professional | | $47.86 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $186.21
| Professional | 50 | $89.13 | $89.13 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,479.11 / $1,479.11
| Facility | | $741.31 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,819.70
| Professional | | $1,819.70 | $1,819.70 | $1,819.70 |