- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $3,801.89 / $7,943.28
| Facility | | $288.40 | $3,801.89 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.91 / $4,677.35 / $6,025.60
| Facility | 50 | $0.91 | $4,677.35 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $407.38
| Professional | | $93.33 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $147.91 / $1,000.00
| Professional | 50 | $38.90 | $147.91 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $331.13 / $436.52
| Professional | | $169.82 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $288.40 / $380.19
| Professional | | $218.78 | $288.40 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $288.40 / $645.65
| Facility | | $186.21 | $288.40 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.91 / $4,677.35 / $6,025.60
| Facility | 50 | $0.91 | $4,677.35 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $426.58
| Professional | | $204.17 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $162.18 / $1,000.00
| Professional | 50 | $38.90 | $162.18 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $309.03 / $316.23
| Facility | | $213.80 | $309.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $257.04 / $407.38
| Facility | | $169.82 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $302.00 / $436.52
| Professional | | $79.43 | $302.00 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $5,495.41 / $6,918.31
| Facility | | $4,073.80 | $5,495.41 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,025.60 / $8,128.31 / $10,232.93
| Facility | 50 | $6,025.60 | $8,128.31 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $478.63
| Professional | | $295.12 | $380.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $8,128.31 / $12,022.64
| Facility | | $2,951.21 | $8,128.31 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $436.52
| Professional | | $204.17 | $309.03 | $436.52 |