- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $3,019.95 / $7,413.10
| Facility | | $257.04 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $812.83 / $1,905.46
| Facility | 50 | $251.19 | $812.83 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $186.21
| Professional | | $50.12 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $223.87 / $380.19
| Professional | 50 | $114.82 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $190.55
| Professional | | $83.18 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $281.84
| Professional | 50 | $107.15 | $151.36 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $7,943.28
| Facility | | $1,000.00 | $1,000.00 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $144.54
| Professional | | $60.26 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $213.80
| Professional | 50 | $91.20 | $134.90 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $128.82
| Professional | | $81.28 | $104.71 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $199.53
| Professional | | $63.10 | $109.65 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $114.82 / $724.44
| Professional | | $52.48 | $114.82 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,760.83 / $7,079.46 / $7,079.46
| Facility | | $6,760.83 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $162.18
| Professional | | $72.44 | $128.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,348.96 / $2,344.23
| Facility | | $213.80 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $91.20 / $181.97
| Professional | | $48.98 | $91.20 | $181.97 |