- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $4,786.30 / $11,481.54
| Facility | | $1,000.00 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $954.99 / $2,344.23 / $16,982.44
| Facility | 50 | $954.99 | $2,344.23 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,818.38 / $5,370.32
| Professional | | $251.19 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,265.80 / $5,888.44 / $14,125.38
| Professional | 50 | $4,265.80 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $7,079.46 / $19,054.61
| Facility | | $3,467.37 | $7,079.46 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $3,090.30 / $7,585.78
| Professional | | $257.04 | $3,090.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $4,466.84 / $9,332.54
| Professional | 50 | $380.19 | $4,466.84 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $35.48 / $416.87 / $870.96
| Professional | AS | $35.48 | $416.87 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $10,000.00 / $23,442.29
| Facility | | $398.11 | $10,000.00 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $2,511.89 / $8,128.31
| Professional | | $281.84 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $5,754.40 / $14,454.40
| Facility | | $2,137.96 | $5,754.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,754.23 / $6,760.83
| Professional | | $251.19 | $2,754.23 | $6,760.83 |