- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,019.95 / $7,413.10
| Facility | | $707.95 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $10,715.19 / $15,848.93
| Facility | 50 | $676.08 | $10,715.19 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,202.26 / $2,398.83
| Professional | | $309.03 | $1,202.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $1,949.84
| Professional | 50 | $117.49 | $234.42 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $457.09
| Professional | | $147.91 | $363.08 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $281.84 / $302.00 / $338.84
| Professional | 50 | $281.84 | $302.00 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,466.84 / $8,709.64
| Facility | | $2,570.40 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,230.27 / $2,137.96
| Professional | | $309.03 | $1,230.27 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,466.84 / $8,709.64
| Facility | | $2,041.74 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $575.44
| Professional | | $177.83 | $354.81 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $446.68
| Facility | | $288.40 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,000.00 / $2,884.03
| Professional | | $354.81 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $11,481.54
| Facility | | $54.95 | $56.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $13,489.63 / $13,489.63
| Professional | | $11,220.18 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,621.81 / $3,715.35
| Facility | | $338.84 | $1,621.81 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $12,589.25
| Facility | 50 | $2,187.76 | $2,187.76 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,258.93 / $3,235.94
| Professional | | $323.59 | $1,258.93 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $2,290.87
| Professional | 50 | $117.49 | $234.42 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,318.26
| Professional | | $32.36 | $33.11 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $3,235.94 / $6,456.54
| Professional | | $338.84 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,380.38 / $3,090.30
| Facility | | $331.13 | $1,380.38 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,000.00 / $3,019.95
| Professional | | $363.08 | $1,000.00 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $4,466.84 / $9,120.11
| Facility | | $1,698.24 | $4,466.84 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,148.15 / $2,454.71
| Professional | | $309.03 | $1,148.15 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,819.70 / $2,137.96
| Professional | | $1,698.24 | $1,819.70 | $2,137.96 |