- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $524.81 / $13,803.84
| Facility | | $229.09 | $524.81 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 50 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $933.25
| Professional | | $173.78 | $302.00 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $467.74 / $1,380.38
| Professional | 50 | $229.09 | $467.74 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $1,122.02
| Professional | | $245.47 | $467.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $1,698.24
| Professional | 50 | $363.08 | $707.95 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $776.25 / $1,230.27
| Facility | | $660.69 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $512.86 / $891.25
| Professional | | $229.09 | $512.86 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $630.96 / $3,801.89
| Facility | | $199.53 | $630.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $489.78 / $758.58
| Professional | | $354.81 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $537.03 / $724.44 / $1,148.15
| Professional | 50 | $537.03 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $2,570.40 / $5,754.40
| Facility | | $223.87 | $2,570.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | 50 | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $501.19 / $2,187.76
| Professional | | $257.04 | $501.19 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $457.09
| Professional | | $32.36 | $33.11 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $3,890.45 / $4,570.88
| Facility | | $389.05 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $1,071.52
| Professional | | $346.74 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $501.19 / $891.25
| Professional | | $281.84 | $501.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $5,248.07
| Facility | | $3,019.95 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $758.58 / $2,187.76
| Professional | | $223.87 | $758.58 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $616.60
| Professional | | $398.11 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,000.00 / $1,513.56
| Professional | | $630.96 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,630.78 / $6,606.93
| Facility | | $2,884.03 | $3,630.78 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $407.38 / $933.25
| Professional | | $208.93 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 50 | $89.13 | $89.13 | $89.13 |