- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,570.40 / $6,606.93
| Facility | | $1,000.00 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $3,630.78
| Facility | 50 | $1,905.46 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $870.96 / $1,778.28
| Professional | | $275.42 | $870.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | 50 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,630.78 / $5,011.87 / $7,244.36
| Facility | | $3,630.78 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $831.76 / $1,621.81
| Professional | | $275.42 | $831.76 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $1,995.26
| Professional | | $281.84 | $457.09 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,698.24 / $6,025.60
| Facility | | $363.08 | $1,698.24 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,737.80 / $8,912.51
| Professional | | $1,148.15 | $1,737.80 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $3,981.07 / $7,413.10
| Facility | | $1,230.27 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $933.25 / $2,041.74
| Professional | | $281.84 | $933.25 | $2,041.74 |