- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,187.76 / $17,378.01
| Facility | | $467.74 | $2,187.76 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 50 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $489.78 / $1,479.11
| Professional | | $263.03 | $489.78 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $2,691.53 / $3,801.89
| Professional | 50 | $645.65 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $524.81
| Professional | | $263.03 | $263.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,548.82 / $3,162.28
| Facility | | $1,202.26 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,778.28 / $2,344.23 / $4,677.35
| Facility | 50 | $1,778.28 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,096.48
| Professional | | $323.59 | $478.63 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $478.63
| Facility | | $346.74 | $346.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $630.96 / $851.14
| Professional | | $288.40 | $630.96 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $616.60 / $1,258.93
| Facility | | $190.55 | $616.60 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,445.44 / $2,344.23 / $4,168.69
| Facility | 50 | $1,445.44 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $602.56 / $1,148.15
| Professional | | $190.55 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $158.49
| Professional | | $32.36 | $33.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $1,000.00
| Facility | | $446.68 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $331.13
| Facility | | $316.23 | $316.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $691.83
| Professional | | $295.12 | $436.52 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,621.81 / $3,162.28
| Facility | | $1,096.48 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,659.59 / $2,398.83 / $4,677.35
| Facility | 50 | $1,659.59 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,148.15
| Professional | | $323.59 | $478.63 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,737.80 / $3,715.35
| Facility | | $346.74 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,023.29
| Professional | | $446.68 | $676.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $288.40 / $537.03
| Professional | | $32.36 | $288.40 | $537.03 |