- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,691.53 / $7,943.28
| Facility | | $524.81 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $5,623.41 / $12,302.69
| Facility | 50 | $416.87 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $338.84 / $933.25
| Professional | 50 | $100.00 | $338.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $309.03
| Professional | 50 | $147.91 | $208.93 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $4,365.16 / $14,125.38
| Facility | | $1,023.29 | $4,365.16 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $281.84
| Facility | | $79.43 | $104.71 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $724.44
| Facility | | $54.95 | $56.23 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $288.40 / $1,995.26
| Facility | | $125.89 | $288.40 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $8,317.64 / $12,882.50
| Facility | 50 | $416.87 | $8,317.64 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $281.84 / $933.25
| Professional | 50 | $100.00 | $281.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $263.03 / $489.78
| Facility | | $120.23 | $263.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $933.25 / $2,290.87
| Facility | | $162.18 | $933.25 | $2,290.87 |