- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $3,548.13 / $10,232.93
| Facility | | $645.65 | $3,548.13 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,949.84 / $6,918.31 / $19,054.61
| Facility | 50 | $1,949.84 | $6,918.31 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,000.00 / $2,691.53
| Professional | | $309.03 | $1,000.00 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $758.58 / $3,548.13
| Professional | 50 | $346.74 | $758.58 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $7,943.28 / $16,982.44
| Facility | | $3,235.94 | $7,943.28 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,445.44 / $3,311.31
| Professional | | $346.74 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $2,137.96 / $4,466.84
| Professional | 50 | $478.63 | $2,137.96 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $4,265.80 / $12,302.69
| Facility | | $436.52 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,174.90 / $3,467.37
| Professional | | $354.81 | $1,174.90 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $7,943.28 / $17,378.01
| Facility | | $2,754.23 | $7,943.28 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,479.11 / $3,235.94
| Professional | | $331.13 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $89.13
| Professional | 50 | $75.86 | $79.43 | $89.13 |