- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,288.25 / $5,623.41
| Facility | | $331.13 | $1,288.25 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $1,288.25 / $8,128.31
| Facility | 50 | $229.09 | $1,288.25 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $1,230.27
| Professional | | $234.42 | $478.63 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $1,659.59 / $3,630.78
| Professional | 50 | $660.69 | $1,659.59 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $229.09 / $229.09
| Professional | | $208.93 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | 50 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $2,511.89
| Facility | | $275.42 | $275.42 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $776.25
| Professional | | $245.47 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $891.25
| Professional | | $234.42 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $1,548.82
| Professional | | $218.78 | $380.19 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $316.23
| Professional | | $257.04 | $257.04 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,380.38 / $3,548.13
| Facility | | $467.74 | $1,380.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $1,023.29
| Professional | | $295.12 | $562.34 | $1,023.29 |