- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,570.40 / $8,317.64
| Facility | | $346.74 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 50 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $251.19
| Professional | | $87.10 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $602.56 / $831.76
| Professional | 50 | $575.44 | $602.56 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,230.27 / $57,543.99
| Facility | | $1,174.90 | $1,230.27 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $147.91 / $218.78
| Professional | | $144.54 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $331.13
| Professional | 50 | $213.80 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $239.88
| Professional | | $93.33 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $245.47 / $309.03
| Professional | | $181.97 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $245.47
| Professional | | $97.72 | $169.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $812.83 / $1,318.26
| Facility | | $331.13 | $812.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | 50 | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,819.70 / $6,606.93
| Facility | | $478.63 | $1,819.70 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $302.00
| Professional | | $89.13 | $128.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $162.18 / $288.40
| Professional | | $30.20 | $162.18 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $138.04 / $138.04
| Facility | | $81.28 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $75.86 / $138.04
| Professional | | $21.38 | $75.86 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $741.31 / $3,890.45
| Facility | | $363.08 | $741.31 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $213.80
| Professional | | $85.11 | $125.89 | $213.80 |