- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $5,011.87 / $7,943.28
| Facility | | $2,511.89 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,344.23 / $5,248.07 / $8,709.64
| Facility | 50 | $2,344.23 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,096.48 / $3,388.44
| Professional | | $338.84 | $1,096.48 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $281.84 / $1,122.02 / $3,801.89
| Professional | 50 | $281.84 | $1,122.02 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $676.08
| Professional | | $223.87 | $316.23 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $478.63 / $2,344.23
| Professional | 50 | $295.12 | $478.63 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,365.16 / $10,000.00
| Facility | | $1,513.56 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,737.80 / $3,467.37
| Professional | | $478.63 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $2,630.27 / $5,248.07
| Professional | 50 | $741.31 | $2,630.27 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $707.95
| Facility | | $446.68 | $524.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,089.30 / $2,691.53
| Professional | | $1,778.28 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,202.26 / $4,073.80
| Professional | | $426.58 | $1,202.26 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,570.40 / $5,011.87
| Professional | | $380.19 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,089.30 / $4,677.35
| Professional | | $380.19 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $7,079.46 / $17,378.01
| Facility | | $1,995.26 | $7,079.46 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,737.80 / $3,630.78
| Professional | | $371.54 | $1,737.80 | $3,630.78 |