- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $977.24 / $3,235.94
| Facility | | $64.57 | $977.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $194.98 / $602.56
| Professional | | $63.10 | $194.98 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $95.50 / $218.78 / $776.25
| Professional | 50 | $95.50 | $218.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1,995.26 / $7,079.46
| Facility | | $1.00 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $354.81 / $891.25
| Professional | | $120.23 | $354.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $524.81 / $1,348.96
| Professional | 50 | $181.97 | $524.81 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $2,344.23
| Facility | | $691.83 | $977.24 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $407.38 / $1,071.52
| Professional | | $144.54 | $407.38 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,778.28
| Facility | | $724.44 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $371.54 / $870.96
| Professional | | $144.54 | $371.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $302.00 / $1,445.44
| Facility | | $69.18 | $302.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $380.19 / $954.99
| Professional | | $190.55 | $380.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,862.09 / $5,370.32
| Facility | | $602.56 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $234.42 / $707.95
| Professional | | $89.13 | $234.42 | $707.95 |