- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,691.53 / $5,248.07
| Facility | | $891.25 | $2,691.53 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $3,019.95 / $11,220.18
| Facility | 50 | $2,089.30 | $3,019.95 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $776.25 / $3,311.31
| Professional | | $295.12 | $776.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $691.83 / $4,570.88
| Professional | 50 | $380.19 | $691.83 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,000.00 / $8,709.64
| Facility | | $56.23 | $1,000.00 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,288.25 / $12,022.64
| Professional | | $316.23 | $1,288.25 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $758.58
| Facility | | $323.59 | $323.59 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,659.59 / $3,630.78
| Professional | | $323.59 | $1,659.59 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $794.33 / $3,467.37
| Professional | | $363.08 | $794.33 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $3,311.31
| Facility | | $263.03 | $371.54 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,995.26 / $3,630.78
| Professional | | $1,548.82 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,380.38 / $3,467.37
| Professional | | $316.23 | $1,380.38 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,548.82 / $5,623.41
| Facility | | $457.09 | $1,548.82 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $1,047.13
| Professional | | $208.93 | $295.12 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | 50 | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,000.00 / $8,709.64
| Facility | | $56.23 | $1,000.00 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,288.25 / $12,022.64
| Professional | | $316.23 | $1,288.25 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,412.54 / $3,630.78
| Professional | | $331.13 | $1,412.54 | $3,630.78 |