- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,174.90 / $4,897.79
| Facility | | $338.84 | $1,174.90 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,467.37 / $5,128.61 / $5,128.61
| Facility | 50 | $3,467.37 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $446.68 / $1,202.26
| Professional | | $234.42 | $446.68 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $676.08 / $2,754.23
| Professional | 50 | $660.69 | $676.08 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $208.93
| Professional | | $104.71 | $104.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | 50 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $302.00 / $380.19
| Professional | | $158.49 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $457.09
| Professional | 50 | $407.38 | $407.38 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $263.03
| Facility | | $199.53 | $199.53 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $467.74 / $691.83
| Professional | | $173.78 | $467.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,412.54 / $4,897.79
| Facility | | $338.84 | $1,412.54 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,467.37 / $5,128.61 / $5,128.61
| Facility | 50 | $3,467.37 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $891.25
| Professional | | $245.47 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $1,659.59 / $2,691.53
| Professional | 50 | $660.69 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $575.44
| Professional | | $194.98 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,445.44 / $3,801.89
| Facility | | $436.52 | $1,445.44 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $794.33
| Professional | | $288.40 | $562.34 | $794.33 |