- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,258.93 / $3,388.44
| Facility | | $154.88 | $1,258.93 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $1,202.26 / $2,691.53
| Facility | 50 | $346.74 | $1,202.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $169.82 / $426.58
| Professional | | $77.62 | $169.82 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $281.84 / $812.83
| Professional | 50 | $128.82 | $281.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,000.00 / $15,135.61
| Facility | | $194.98 | $1,000.00 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $575.44
| Professional | | $83.18 | $190.55 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $223.87
| Facility | | $95.50 | $95.50 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $199.53 / $389.05
| Professional | | $95.50 | $199.53 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $446.68
| Professional | | $83.18 | $190.55 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $3,311.31
| Facility | | $75.86 | $107.15 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $323.59
| Professional | | $199.53 | $245.47 | $323.59 |
- 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
- $89.13 / $194.98 / $457.09
| Professional | | $89.13 | $194.98 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,023.29 / $2,344.23
| Facility | | $524.81 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $169.82 / $346.74
| Professional | | $147.91 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | 50 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,000.00 / $15,135.61
| Facility | | $194.98 | $1,000.00 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $575.44
| Professional | | $83.18 | $190.55 | $575.44 |
- 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
- $89.13 / $204.17 / $467.74
| Professional | | $89.13 | $204.17 | $467.74 |