- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $2,238.72 / $10,715.19
| Facility | | $95.50 | $2,238.72 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,570.40 / $3,890.45 / $4,265.80
| Facility | 50 | $2,570.40 | $3,890.45 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $114.82 / $257.04
| Professional | | $52.48 | $114.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $446.68
| Professional | 50 | $162.18 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $154.88
| Professional | | $67.61 | $93.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $234.42
| Professional | 50 | $102.33 | $141.25 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $61.66
| Facility | | $52.48 | $52.48 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $123.03 / $208.93
| Professional | | $60.26 | $123.03 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $21,379.62
| Facility | | $380.19 | $380.19 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $123.03 / $208.93
| Professional | | $60.26 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $38.90
| Professional | | $32.36 | $33.11 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $436.52
| Facility | | $100.00 | $100.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $117.49 / $199.53
| Professional | | $51.29 | $117.49 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,737.80 / $4,073.80
| Facility | | $537.03 | $1,737.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $104.71 / $177.83
| Professional | | $51.29 | $104.71 | $177.83 |