- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $3,019.95 / $5,128.61
| Facility | | $208.93 | $3,019.95 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.83 / $1,659.59 / $2,187.76
| Facility | 50 | $0.83 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $457.09
| Professional | | $128.82 | $162.18 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $4,677.35 / $45,708.82
| Facility | | $380.19 | $4,677.35 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $223.87 / $1,122.02
| Professional | | $131.83 | $223.87 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Professional | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $302.00 / $575.44
| Professional | | $158.49 | $302.00 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $3,630.78
| Facility | | $154.88 | $213.80 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $269.15
| Professional | | $154.88 | $194.98 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,630.78 / $8,511.38
| Facility | | $1,778.28 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $257.04 / $436.52
| Professional | | $141.25 | $257.04 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $4,677.35 / $45,708.82
| Facility | | $380.19 | $4,677.35 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $223.87 / $1,122.02
| Professional | | $131.83 | $223.87 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $251.19 / $512.86
| Professional | | $165.96 | $251.19 | $512.86 |