- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,479.11 / $3,162.28
| Facility | | $323.59 | $1,479.11 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $977.24
| Professional | | $151.36 | $281.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $2,398.83
| Professional | 50 | $234.42 | $389.05 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $812.83
| Professional | | $229.09 | $346.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $1,230.27
| Professional | 50 | $371.54 | $524.81 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $891.25 / $1,412.54
| Facility | | $758.58 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $616.60 / $1,230.27
| Professional | | $251.19 | $616.60 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $407.38 / $3,548.13
| Facility | | $173.78 | $407.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $758.58
| Professional | | $338.84 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $724.44 / $1,148.15
| Professional | 50 | $512.86 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $436.52 / $5,248.07
| Facility | | $173.78 | $436.52 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $602.56 / $2,238.72
| Professional | | $288.40 | $602.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | 50 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $363.08
| Professional | | $32.36 | $33.11 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $3,890.45 / $4,570.88
| Facility | | $323.59 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $616.60 / $1,047.13
| Professional | | $354.81 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $467.74 / $954.99
| Professional | | $251.19 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,890.45 / $3,890.45
| Facility | | $741.31 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,318.26 / $2,290.87
| Professional | | $288.40 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,348.96
| Professional | | $741.31 | $741.31 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,513.56 / $2,754.23
| Professional | | $707.95 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,311.31 / $6,606.93
| Facility | | $2,754.23 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $512.86 / $1,737.80
| Professional | | $95.50 | $512.86 | $1,737.80 |