- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $3,630.78 / $8,317.64
| Facility | | $309.03 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $707.95
| Facility | 50 | $407.38 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,698.24 / $3,630.78
| Professional | | $190.55 | $1,698.24 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 50 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $616.60 / $2,570.40
| Professional | | $190.55 | $616.60 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $281.84 / $933.25 / $3,890.45
| Professional | 50 | $281.84 | $933.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $4,168.69 / $12,022.64
| Professional | | $186.21 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $562.34 / $4,897.79
| Professional | | $208.93 | $562.34 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,905.46 / $5,128.61
| Professional | | $147.91 | $1,905.46 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,888.44 / $6,760.83
| Professional | | $4,677.35 | $5,888.44 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,584.89 / $4,073.80
| Facility | | $204.17 | $1,584.89 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $10,000.00
| Facility | | $169.82 | $263.03 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $3,630.78 / $10,000.00
| Professional | | $1,949.84 | $3,630.78 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $8,511.38 / $17,378.01
| Facility | | $5,495.41 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,230.27 / $5,128.61
| Professional | | $177.83 | $1,230.27 | $5,128.61 |