- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,951.21 / $10,715.19
| Facility | | $489.78 | $2,951.21 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,570.40 / $5,623.41 / $21,877.62
| Facility | 50 | $2,570.40 | $5,623.41 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $870.96 / $1,819.70
| Professional | | $144.54 | $870.96 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $5,495.41
| Professional | 50 | $794.33 | $794.33 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Professional | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | 50 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,884.03 / $7,943.28
| Facility | | $1,000.00 | $2,884.03 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $645.65 / $1,479.11
| Professional | | $151.36 | $645.65 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $223.87 / $977.24 / $2,187.76
| Professional | 50 | $223.87 | $977.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $147.91 / $169.82
| Facility | | $141.25 | $147.91 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $234.42 / $21,379.62
| Facility | | $123.03 | $234.42 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $489.78 / $1,659.59
| Professional | | $173.78 | $489.78 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $21,379.62
| Facility | | $2,754.23 | $2,754.23 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $489.78 / $1,698.24
| Professional | | $169.82 | $489.78 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $2,187.76
| Facility | | $100.00 | $100.00 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $380.19 / $1,479.11
| Professional | | $131.83 | $380.19 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,570.40 / $5,495.41
| Facility | | $1,348.96 | $2,570.40 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $676.08 / $1,548.82
| Professional | | $141.25 | $676.08 | $1,548.82 |