- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $3,090.30 / $10,964.78
| Facility | | $169.82 | $3,090.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $912.01 / $31,622.78
| Facility | 50 | $208.93 | $912.01 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $436.52
| Professional | | $114.82 | $169.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $389.05 / $891.25
| Professional | 50 | $177.83 | $389.05 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $134.90 / $147.91
| Professional | | $125.89 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $208.93
| Professional | 50 | $204.17 | $204.17 | $208.93 |
- 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
- $125.89 / $154.88 / $354.81
| Professional | | $125.89 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $524.81
| Professional | 50 | $186.21 | $234.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $4,073.80
| Facility | | $165.96 | $165.96 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $190.55
| Professional | | $165.96 | $165.96 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $199.53 / $53,703.18
| Facility | | $34.67 | $199.53 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $630.96
| Professional | | $128.82 | $213.80 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $407.38
| Facility | | $100.00 | $134.90 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $229.09 / $323.59
| Professional | | $154.88 | $229.09 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $288.40
| Professional | | $114.82 | $173.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,380.38
| Facility | | $446.68 | $446.68 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $2,137.96
| Facility | 50 | $1,778.28 | $1,778.28 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $50,118.72 / $75,857.76
| Facility | | $138.04 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $398.11
| Professional | | $162.18 | $234.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,398.83 / $4,897.79
| Facility | | $891.25 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $186.21 / $549.54
| Professional | | $109.65 | $186.21 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $602.56
| Facility | | $97.72 | $138.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $380.19
| Professional | | $112.20 | $162.18 | $380.19 |