- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,019.95 / $10,715.19
| Facility | | $346.74 | $3,019.95 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,388.44 / $3,388.44 / $5,888.44
| Facility | 50 | $3,388.44 | $3,388.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $707.95
| Professional | | $213.80 | $338.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | 50 | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,818.38 / $7,943.28
| Facility | | $1,000.00 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $478.63
| Professional | | $190.55 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $724.44
| Professional | 50 | $281.84 | $416.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $21,379.62
| Facility | | $169.82 | $169.82 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $562.34
| Professional | | $223.87 | $323.59 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $21,379.62
| Facility | | $4,168.69 | $4,168.69 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $562.34
| Professional | | $229.09 | $323.59 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $2,041.74
| Facility | | $100.00 | $100.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $588.84
| Professional | | $199.53 | $331.13 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,570.40 / $5,248.07
| Facility | | $1,230.27 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $524.81
| Professional | | $208.93 | $331.13 | $524.81 |