- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $3,801.89 / $6,760.83
| Facility | | $229.09 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,000.00 / $3,388.44
| Professional | | $154.88 | $1,000.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $389.05 / $1,737.80
| Professional | 50 | $125.89 | $389.05 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $4,786.30
| Professional | | $363.08 | $446.68 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $2,290.87 / $5,370.32
| Professional | | $151.36 | $2,290.87 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $4,570.88 / $17,378.01
| Facility | | $389.05 | $4,570.88 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $3,467.37 / $6,309.57
| Professional | | $416.87 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $3,715.35 / $5,370.32
| Professional | | $363.08 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $5,011.87
| Professional | | $331.13 | $537.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $4,677.35 / $5,370.32
| Professional | | $5.01 | $4,677.35 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $10,232.93 / $18,620.87
| Facility | | $5,495.41 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,737.80 / $5,128.61
| Professional | | $181.97 | $1,737.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $3,388.44
| Professional | | $295.12 | $346.74 | $3,388.44 |