- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,995.26 / $10,471.29
| Facility | | $309.03 | $1,995.26 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,467.37 / $4,265.80 / $4,265.80
| Facility | 50 | $3,467.37 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $630.96
| Professional | | $309.03 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,162.28 / $3,548.13 / $3,548.13
| Professional | 50 | $3,162.28 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,466.84 / $11,481.54
| Facility | | $2,630.27 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $660.69
| Professional | | $354.81 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $537.03 / $645.65 / $1,000.00
| Professional | 50 | $537.03 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $478.63
| Facility | | $288.40 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $416.87 / $489.78
| Professional | | $295.12 | $416.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $2,511.89
| Facility | | $549.54 | $549.54 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $616.60 / $2,630.27
| Professional | | $331.13 | $616.60 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $4,677.35 / $8,511.38
| Facility | | $741.31 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $660.69
| Professional | | $281.84 | $457.09 | $660.69 |