- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $2,344.23 / $7,244.36
| Facility | | $100.00 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $870.96 / $1,995.26 / $3,235.94
| Facility | 50 | $870.96 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $245.47
| Professional | | $56.23 | $95.50 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $389.05 / $977.24
| Professional | 50 | $91.20 | $389.05 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $426.58
| Professional | | $104.71 | $181.97 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $100.00 / $169.82
| Professional | | $95.50 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $151.36 / $245.47
| Professional | 50 | $141.25 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $223.87
| Professional | | $61.66 | $109.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $218.78
| Professional | | $125.89 | $173.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $234.42
| Professional | | $95.50 | $144.54 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,096.48 / $2,691.53
| Facility | | $645.65 | $1,096.48 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $5,011.87
| Facility | 50 | $1,659.59 | $1,659.59 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $426.58
| Professional | | $104.71 | $181.97 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,412.54 / $6,165.95
| Facility | | $87.10 | $1,412.54 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | 50 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $239.88
| Professional | | $57.54 | $102.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $158.49 / $245.47
| Professional | | $30.20 | $158.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $93.33 / $309.03
| Facility | | $26.30 | $93.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $93.33 / $309.03
| Professional | | $28.84 | $93.33 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,584.89 / $3,890.45
| Facility | | $575.44 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $199.53
| Professional | | $56.23 | $100.00 | $199.53 |