- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $933.25 / $8,709.64
| Facility | | $537.03 | $933.25 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $5,754.40 / $8,709.64
| Facility | 50 | $1,288.25 | $5,754.40 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $602.56 / $1,380.38
| Professional | | $489.78 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $1,096.48 / $3,388.44
| Professional | 50 | $645.65 | $1,096.48 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,548.82
| Professional | 50 | $691.83 | $691.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $1,737.80
| Professional | | $549.54 | $691.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $1,288.25
| Professional | | $588.84 | $776.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,000.00
| Professional | | $933.25 | $933.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $891.25
| Facility | | $512.86 | $660.69 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,890.45 / $6,760.83
| Facility | | $1,621.81 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $588.84 / $1,174.90
| Professional | | $478.63 | $588.84 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $42,657.95
| Facility | | $6,309.57 | $6,309.57 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $5,128.61
| Professional | | $4,466.84 | $4,466.84 | $5,128.61 |