- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $4,365.16 / $10,000.00
| Facility | | $323.59 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $7,762.47 / $11,220.18
| Facility | 50 | $2,137.96 | $7,762.47 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $870.96 / $3,311.31
| Professional | | $323.59 | $870.96 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $616.60 / $4,897.79
| Professional | 50 | $234.42 | $616.60 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $501.19
| Professional | | $173.78 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $223.87 / $467.74 / $954.99
| Professional | 50 | $223.87 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $4,265.80 / $12,302.69
| Facility | | $1,348.96 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,905.46 / $2,344.23
| Professional | | $380.19 | $1,905.46 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $616.60 / $5,495.41
| Facility | | $323.59 | $616.60 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,380.38 / $3,467.37
| Professional | | $389.05 | $1,380.38 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,659.59 / $2,818.38
| Professional | | $1,047.13 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $281.84 / $2,691.53
| Professional | | $32.36 | $281.84 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $11,220.18 / $18,620.87
| Facility | | $3,162.28 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,348.96 / $3,090.30
| Professional | | $338.84 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $89.13
| Professional | 50 | $75.86 | $75.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,513.56 / $2,238.72
| Professional | | $281.84 | $1,513.56 | $2,238.72 |