- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,819.70 / $3,548.13
| Facility | | $186.21 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $1,778.28 / $4,570.88
| Facility | 50 | $208.93 | $1,778.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $186.21 / $691.83
| Professional | | $57.54 | $186.21 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $213.80 / $1,148.15
| Professional | 50 | $87.10 | $213.80 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $190.55 / $707.95
| Professional | | $61.66 | $190.55 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $158.49
| Facility | | $67.61 | $67.61 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $363.08 / $537.03
| Professional | | $89.13 | $363.08 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $169.82 / $549.54
| Professional | | $69.18 | $169.82 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $74.13 / $3,311.31
| Facility | | $54.95 | $74.13 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $354.81 / $457.09
| Professional | | $288.40 | $354.81 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $218.78 / $630.96
| Professional | | $61.66 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,318.26 / $1,949.84
| Facility | | $467.74 | $1,318.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $186.21 / $194.98
| Professional | | $67.61 | $186.21 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $190.55 / $707.95
| Professional | | $61.66 | $190.55 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,862.09 / $2,818.38
| Facility | | $524.81 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $173.78 / $645.65
| Professional | | $64.57 | $173.78 | $645.65 |