- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $4,786.30 / $8,317.64
| Facility | | $2,187.76 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $8,317.64
| Facility | 50 | $4,786.30 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $851.14 / $2,691.53
| Professional | | $446.68 | $851.14 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $512.86
| Professional | | $251.19 | $501.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,388.44 / $6,309.57
| Facility | | $831.76 | $3,388.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $851.14 / $1,548.82
| Professional | | $645.65 | $851.14 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,096.48
| Professional | | $501.19 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $812.83 / $8,912.51
| Facility | | $524.81 | $812.83 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $851.14
| Facility | AS | $141.25 | $141.25 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $5,248.07
| Professional | | $489.78 | $707.95 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,570.88 / $10,000.00
| Facility | | $2,754.23 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $602.56 / $1,023.29
| Professional | | $467.74 | $602.56 | $1,023.29 |