- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,862.09 / $1,862.09
| Facility | | $147.91 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,513.56 / $3,801.89
| Professional | | $147.91 | $1,513.56 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $12,882.50 / $31,622.78
| Facility | | $338.84 | $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
- $263.03 / $912.01 / $5,495.41
| Professional | | $263.03 | $912.01 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $1,348.96 / $8,317.64
| Professional | 50 | $389.05 | $1,348.96 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $6,309.57 / $14,791.08
| Facility | | $3,890.45 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $2,344.23 / $6,760.83
| Professional | | $331.13 | $2,344.23 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $5,754.40 / $11,220.18
| Facility | | $4,570.88 | $5,754.40 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $2,290.87 / $6,025.60
| Professional | | $309.03 | $2,290.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,398.83 / $7,762.47
| Facility | | $190.55 | $2,398.83 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $4,570.88 / $10,964.78
| Professional | | $2,290.87 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,888.44 / $18,197.01
| Facility | | $1,584.89 | $5,888.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $1,778.28 / $6,165.95
| Professional | | $223.87 | $1,778.28 | $6,165.95 |