- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $4,897.79 / $11,220.18
| Facility | | $478.63 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $7,079.46 / $11,220.18
| Facility | 50 | $4,786.30 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $426.58 / $1,122.02
| Professional | | $316.23 | $426.58 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $776.25 / $1,230.27
| Professional | 50 | $295.12 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,677.35 / $10,000.00
| Facility | | $2,238.72 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $831.76
| Professional | | $354.81 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $1,230.27
| Professional | 50 | $524.81 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $309.03 / $524.81
| Professional | | $275.42 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $13,182.57 / $17,782.79
| Facility | | $11,481.54 | $13,182.57 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $776.25
| Professional | | $275.42 | $457.09 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,778.28 / $26,302.68
| Facility | | $338.84 | $1,778.28 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $524.81 / $6,165.95
| Professional | | $331.13 | $524.81 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,090.30 / $6,025.60
| Facility | | $2,137.96 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $645.65
| Professional | | $331.13 | $446.68 | $645.65 |