- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,621.81 / $4,677.35
| Facility | | $141.25 | $1,621.81 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $977.24 / $2,754.23 / $4,897.79
| Facility | 50 | $977.24 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $162.18 / $380.19
| Professional | | $77.62 | $162.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $645.65
| Professional | 50 | $147.91 | $269.15 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $162.18
| Professional | | $75.86 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $245.47
| Professional | 50 | $102.33 | $141.25 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $138.04
| Professional | | $60.26 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $123.03 / $208.93
| Professional | 50 | $89.13 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $134.90
| Facility | | $79.43 | $102.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $204.17 / $346.74
| Professional | | $154.88 | $204.17 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $21,379.62
| Facility | | $83.18 | $134.90 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $316.23
| Professional | | $83.18 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $2,951.21
| Facility | | $691.83 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $151.36 / $295.12
| Professional | | $81.28 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $281.84 / $380.19
| Professional | 50 | $120.23 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $69.18
| Professional | | $32.36 | $33.11 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $165.96 / $269.15
| Professional | | $75.86 | $165.96 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,047.13 / $3,235.94
| Facility | | $478.63 | $1,047.13 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $263.03
| Professional | | $69.18 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | 50 | $79.43 | $79.43 | $85.11 |