- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,691.53 / $5,128.61
| Facility | | $213.80 | $2,691.53 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | 50 | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $870.96
| Professional | | $213.80 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $1,122.02
| Professional | 50 | $316.23 | $316.23 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,311.31 / $28,840.32
| Facility | | $501.19 | $3,311.31 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $912.01
| Professional | | $218.78 | $380.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $537.03
| Facility | | $234.42 | $234.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $478.63 / $794.33
| Professional | | $309.03 | $478.63 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $1,071.52
| Professional | | $295.12 | $501.19 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $3,630.78
| Facility | | $208.93 | $281.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $457.09 / $645.65
| Professional | | $371.54 | $457.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,630.78 / $8,511.38
| Facility | | $1,778.28 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $831.76
| Professional | | $229.09 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,466.84 / $10,471.29
| Facility | | $2,884.03 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $3,311.31 / $28,840.32
| Facility | | $501.19 | $3,311.31 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $912.01
| Professional | | $218.78 | $380.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,548.13 / $8,511.38
| Facility | | $1,445.44 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $912.01
| Professional | | $245.47 | $436.52 | $912.01 |