- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $3,388.44 / $9,120.11
| Facility | | $398.11 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,819.70 / $6,025.60 / $10,232.93
| Facility | 50 | $1,819.70 | $6,025.60 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $269.15 / $912.01
| Professional | | $131.83 | $269.15 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $407.38 / $2,041.74
| Professional | 50 | $117.49 | $407.38 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $208.93
| Professional | | $104.71 | $162.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $281.84
| Professional | 50 | $213.80 | $213.80 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,570.88 / $6,025.60
| Facility | | $2,137.96 | $4,570.88 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $389.05 / $794.33
| Professional | | $190.55 | $389.05 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,888.44 / $10,000.00 / $10,964.78
| Facility | | $5,888.44 | $10,000.00 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $323.59 / $691.83
| Professional | | $162.18 | $323.59 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $512.86 / $1,862.09
| Professional | | $199.53 | $512.86 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $194.98 / $489.78
| Professional | | $181.97 | $194.98 | $489.78 |
- 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
- $2,187.76 / $3,467.37 / $7,585.78
| Facility | | $2,187.76 | $3,467.37 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $416.87 / $831.76
| Professional | | $169.82 | $416.87 | $831.76 |