- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $5,495.41 / $12,302.69
| Facility | | $1,862.09 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,495.41 / $8,317.64 / $8,709.64
| Facility | 50 | $5,495.41 | $8,317.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $660.69 / $1,202.26
| Professional | | $457.09 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $660.69 / $912.01
| Professional | | $354.81 | $660.69 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $4,570.88 / $15,135.61
| Facility | | $1,174.90 | $4,570.88 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $758.58 / $1,122.02
| Professional | | $489.78 | $758.58 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $707.95 / $1,000.00
| Facility | | $602.56 | $707.95 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $616.60 / $707.95
| Professional | | $478.63 | $616.60 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,244.36 / $10,000.00
| Facility | | $4,168.69 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $794.33 / $1,318.26
| Professional | | $512.86 | $794.33 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $676.08 / $1,548.82
| Professional | | $524.81 | $676.08 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $6,456.54 / $6,456.54
| Facility | | $3,715.35 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $912.01 / $1,071.52
| Professional | | $512.86 | $912.01 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $5,011.87 / $8,511.38
| Facility | | $1,513.56 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,174.90
| Professional | | $426.58 | $660.69 | $1,174.90 |