- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $1,380.38 / $3,548.13
| Facility | | $57.54 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 50 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $181.97 / $776.25
| Professional | | $56.23 | $181.97 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $177.83 / $977.24
| Professional | 50 | $81.28 | $177.83 | $977.24 |
- 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
- $107.15 / $331.13 / $831.76
| Professional | | $107.15 | $331.13 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $467.74 / $1,258.93
| Professional | 50 | $158.49 | $467.74 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $912.01 / $2,187.76
| Facility | | $645.65 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $316.23 / $1,000.00
| Professional | | $128.82 | $316.23 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $1,659.59
| Facility | | $691.83 | $851.14 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $295.12 / $812.83
| Professional | | $125.89 | $295.12 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $323.59 / $1,445.44
| Facility | | $77.62 | $323.59 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $1,949.84 / $2,089.30
| Facility | 50 | $489.78 | $1,949.84 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $346.74 / $891.25
| Professional | | $181.97 | $346.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | 50 | $812.83 | $812.83 | $812.83 |
- 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
- $77.62 / $208.93 / $645.65
| Professional | | $77.62 | $208.93 | $645.65 |