- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $5,128.61 / $11,748.98
| Facility | | $812.83 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,630.27 / $3,715.35 / $12,589.25
| Facility | 50 | $2,630.27 | $3,715.35 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $891.25 / $2,290.87
| Professional | | $588.84 | $891.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $812.83 / $1,380.38 / $2,041.74
| Professional | 50 | $812.83 | $1,380.38 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,818.38 / $7,943.28
| Facility | | $1,071.52 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $707.95 / $1,288.25
| Professional | | $537.03 | $707.95 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $1,071.52 / $1,905.46
| Professional | 50 | $794.33 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $1,288.25
| Facility | | $707.95 | $707.95 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $21,379.62
| Facility | | $1,047.13 | $1,047.13 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $812.83 / $1,412.54
| Professional | | $549.54 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,047.13 / $21,379.62
| Facility | | $794.33 | $1,047.13 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $812.83 / $1,318.26
| Professional | | $537.03 | $812.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Professional | 50 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $295.12
| Professional | | $32.36 | $33.11 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $2,951.21
| Facility | | $100.00 | $100.00 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,513.56
| Professional | | $537.03 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $4,265.80 / $7,413.10
| Facility | | $1,778.28 | $4,265.80 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $724.44 / $1,202.26
| Professional | | $489.78 | $724.44 | $1,202.26 |