- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,862.09 / $5,128.61
| Facility | | $162.18 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,691.53 / $6,309.57 / $7,762.47
| Facility | 50 | $2,691.53 | $6,309.57 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $478.63 / $1,513.56
| Professional | | $95.50 | $478.63 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $323.59 / $3,388.44
| Professional | 50 | $165.96 | $323.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $128.82
| Professional | | $109.65 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $1,348.96
| Professional | 50 | $162.18 | $190.55 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $323.59 / $1,258.93
| Professional | | $141.25 | $323.59 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $346.74 / $1,148.15
| Professional | | $131.83 | $346.74 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $389.05 / $870.96
| Facility | | $97.72 | $389.05 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $1,445.44
| Professional | | $457.09 | $457.09 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,137.96 / $4,265.80
| Facility | | $954.99 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $407.38 / $933.25
| Professional | | $104.71 | $407.38 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,623.41 / $5,623.41
| Facility | | $56.23 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,786.30 / $4,786.30
| Professional | | $4,073.80 | $4,786.30 | $4,786.30 |