- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $776.25 / $6,606.93
| Facility | | $288.40 | $776.25 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $2,818.38 / $8,128.31
| Facility | 50 | $891.25 | $2,818.38 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $707.95
| Professional | | $239.88 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $724.44 / $1,288.25
| Professional | 50 | $134.90 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $117.49
| Professional | | $100.00 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $346.74
| Professional | 50 | $151.36 | $213.80 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $23,988.33 / $33,113.11
| Facility | | $3,715.35 | $23,988.33 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $660.69
| Professional | | $275.42 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $645.65 / $1,000.00
| Professional | 50 | $416.87 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $239.88 / $275.42
| Facility | | $234.42 | $239.88 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $831.76
| Professional | | $251.19 | $436.52 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $6,025.60 / $14,125.38
| Facility | | $3,388.44 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $354.81 / $660.69
| Professional | | $234.42 | $354.81 | $660.69 |