- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $2,818.38 / $5,623.41
| Facility | | $123.03 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $4,073.80
| Facility | 50 | $512.86 | $512.86 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $316.23
| Professional | | $120.23 | $147.91 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $194.98
| Professional | 50 | $134.90 | $190.55 | $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
- $104.71 / $173.78 / $426.58
| Professional | | $104.71 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $331.13
| Facility | | $147.91 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $331.13
| Professional | | $147.91 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $316.23 / $316.23
| Professional | 50 | $302.00 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $234.42 / $416.87
| Professional | | $114.82 | $234.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $3,630.78
| Facility | | $112.20 | $162.18 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $181.97 / $234.42
| Professional | | $154.88 | $181.97 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $371.54
| Professional | | $128.82 | $190.55 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- 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
- $104.71 / $173.78 / $426.58
| Professional | | $104.71 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,412.54 / $2,818.38
| Facility | | $501.19 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $380.19
| Professional | | $123.03 | $177.83 | $380.19 |