- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,862.09 / $1,862.09
| Facility | | $162.18 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $1,548.82 / $2,511.89
| Professional | | $158.49 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Professional | 50 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $12,882.50 / $31,622.78
| Facility | | $2,041.74 | $12,882.50 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $16,218.10 / $26,302.68 / $74,131.02
| Facility | 50 | $16,218.10 | $26,302.68 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,000.00 / $5,623.41
| Professional | | $288.40 | $1,000.00 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $1,479.11 / $8,511.38
| Professional | 50 | $426.58 | $1,479.11 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,309.57 / $15,135.61
| Facility | | $4,365.16 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,398.83 / $6,918.31
| Professional | | $346.74 | $2,398.83 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,623.41 / $11,220.18
| Facility | | $4,677.35 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,047.13 / $6,025.60
| Professional | | $338.84 | $1,047.13 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,398.83 / $9,332.54
| Facility | | $213.80 | $2,398.83 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $4,168.69 / $10,471.29
| Professional | | $2,290.87 | $4,168.69 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $6,760.83 / $18,197.01
| Facility | | $1,584.89 | $6,760.83 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,819.70 / $6,165.95
| Professional | | $239.88 | $1,819.70 | $6,165.95 |