- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $2,630.27 / $6,918.31
| Facility | | $87.10 | $2,630.27 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $4,168.69 / $10,000.00
| Facility | 50 | $776.25 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $104.71 / $309.03
| Professional | | $50.12 | $104.71 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $144.54 / $457.09
| Professional | 50 | $75.86 | $144.54 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $95.50 / $120.23
| Professional | | $42.66 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $169.82
| Professional | 50 | $151.36 | $151.36 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $281.84
| Professional | | $72.44 | $89.13 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $416.87
| Professional | 50 | $107.15 | $134.90 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $1,258.93 / $4,073.80
| Facility | | $74.13 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $158.49
| Professional | | $74.13 | $74.13 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,318.26 / $53,703.18
| Facility | | $87.10 | $1,318.26 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | 53 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $131.83 / $407.38
| Professional | | $60.26 | $131.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $165.96
| Facility | | $51.29 | $60.26 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $288.40
| Professional | | $128.82 | $190.55 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $234.42
| Professional | | $87.10 | $134.90 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,288.25 / $2,570.40
| Facility | | $630.96 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 50 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $154.88
| Professional | | $75.86 | $104.71 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $229.09
| Professional | 50 | $151.36 | $151.36 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $50,118.72 / $75,857.76
| Facility | | $67.61 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $398.11
| Professional | | $128.82 | $181.97 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,511.89 / $4,897.79
| Facility | | $1,318.26 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $131.83 / $457.09
| Professional | | $52.48 | $131.83 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $323.59
| Facility | | $41.69 | $60.26 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $263.03
| Professional | | $91.20 | $131.83 | $263.03 |