- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.12 / $2,187.76 / $6,760.83
| Facility | | $1.12 | $2,187.76 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.55 / $1,479.11 / $2,344.23
| Facility | 50 | $0.55 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $173.78 / $645.65
| Professional | | $54.95 | $173.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $199.53 / $831.76
| Professional | 50 | $83.18 | $199.53 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $204.17 / $263.03
| Professional | | $58.88 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $302.00 / $537.03
| Professional | 50 | $81.28 | $302.00 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $4,265.80 / $12,302.69
| Facility | | $263.03 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $190.55 / $257.04
| Professional | | $53.70 | $190.55 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $323.59
| Facility | | $100.00 | $100.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $141.25 / $354.81
| Professional | | $56.23 | $141.25 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $6,760.83
| Facility | | $1,348.96 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $245.47
| Professional | | $104.71 | $181.97 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $295.12
| Professional | | $32.36 | $44.67 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,548.82 / $3,890.45
| Facility | | $331.13 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $128.82 / $275.42
| Professional | | $50.12 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $162.18 / $257.04
| Professional | | $44.67 | $162.18 | $257.04 |