- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $3,467.37 / $10,232.93
| Facility | | $416.87 | $3,467.37 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $3,548.13 / $5,248.07
| Facility | 50 | $891.25 | $3,548.13 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $1,905.46
| Professional | | $263.03 | $371.54 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $912.01 / $3,235.94
| Professional | 50 | $616.60 | $912.01 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $288.40
| Professional | | $251.19 | $251.19 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | 50 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,019.95 / $7,943.28
| Facility | | $1,000.00 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $660.69
| Professional | | $269.15 | $380.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $575.44 / $977.24
| Professional | 50 | $398.11 | $575.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $288.40 / $323.59
| Facility | | $269.15 | $288.40 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $707.95
| Professional | | $295.12 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,445.44 / $2,754.23
| Facility | | $933.25 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $707.95
| Professional | | $295.12 | $436.52 | $707.95 |
- 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
- $100.00 / $100.00 / $1,905.46
| Facility | | $100.00 | $100.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $724.44
| Professional | | $257.04 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $4,168.69 / $7,244.36
| Facility | | $1,174.90 | $4,168.69 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $630.96
| Professional | | $269.15 | $389.05 | $630.96 |