- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $3,890.45 / $8,317.64
| Facility | | $954.99 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 50 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $398.11
| Professional | | $128.82 | $257.04 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $2,691.53 / $57,543.99
| Facility | | $2,630.27 | $2,691.53 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $263.03 / $467.74
| Professional | | $257.04 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $398.11 / $707.95
| Professional | 50 | $380.19 | $398.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $426.58
| Professional | | $125.89 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $457.09
| Professional | | $331.13 | $331.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $281.84 / $467.74
| Professional | | $134.90 | $281.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,570.40 / $8,317.64
| Facility | | $724.44 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $446.68
| Professional | | $128.82 | $257.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $416.87 / $645.65
| Professional | | $380.19 | $416.87 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $275.42 / $467.74
| Facility | | $42.66 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $263.03 / $416.87
| Professional | | $104.71 | $263.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,570.40 / $5,011.87
| Facility | | $1,000.00 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $239.88 / $436.52
| Professional | | $123.03 | $239.88 | $436.52 |