- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,288.25 / $2,691.53
| Facility | | $467.74 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $501.19 / $2,089.30 / $3,548.13
| Facility | 50 | $501.19 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $398.11
| Professional | | $83.18 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $138.04 / $371.54 / $933.25
| Professional | 50 | $138.04 | $371.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $151.36 / $218.78
| Professional | | $77.62 | $151.36 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $245.47 / $457.09
| Professional | 50 | $123.03 | $245.47 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,479.11 / $2,041.74
| Facility | | $724.44 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $338.84
| Professional | | $109.65 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $302.00
| Professional | | $100.00 | $181.97 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $30,199.52
| Facility | | $2,754.23 | $2,754.23 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,412.54 / $2,884.03
| Facility | | $741.31 | $1,412.54 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $162.18 / $338.84
| Professional | | $85.11 | $162.18 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | 50 | $89.13 | $89.13 | $89.13 |