- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $407.38 / $6,760.83
| Facility | | $91.20 | $407.38 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.52
| Facility | 50 | $0.52 | $0.52 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $120.23 / $363.08
| Professional | | $58.88 | $120.23 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $831.76 / $831.76
| Professional | 50 | $338.84 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $346.74
| Professional | | $95.50 | $181.97 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $138.04 / $724.44
| Professional | | $63.10 | $138.04 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $218.78 / $2,089.30
| Facility | | $97.72 | $218.78 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $186.21 / $912.01
| Professional | | $89.13 | $186.21 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $295.12
| Professional | | $131.83 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $295.12
| Professional | | $125.89 | $234.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $15,848.93 / $44,668.36
| Facility | | $12,022.64 | $15,848.93 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $134.90 / $275.42
| Professional | | $63.10 | $134.90 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,862.09 / $5,128.61
| Facility | | $1,023.29 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $109.65 / $234.42
| Professional | | $57.54 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $263.03
| Professional | | $123.03 | $177.83 | $263.03 |