- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,511.89 / $6,606.93
| Facility | | $758.58 | $2,511.89 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $14,125.38 / $27,542.29
| Facility | 50 | $1,122.02 | $14,125.38 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $758.58 / $3,019.95
| Professional | | $309.03 | $758.58 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $269.15 / $489.78 / $2,398.83
| Professional | 50 | $269.15 | $489.78 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $194.98 / $263.03
| Professional | | $177.83 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $275.42 / $302.00 / $549.54
| Professional | 50 | $275.42 | $302.00 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $10,000.00 / $17,782.79
| Facility | | $5,370.32 | $10,000.00 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $794.33 / $3,388.44
| Professional | | $501.19 | $794.33 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $4,677.35 / $4,677.35
| Facility | | $39.81 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,000.00 / $3,162.28
| Professional | | $398.11 | $1,000.00 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $6,760.83 / $12,882.50
| Facility | | $1,318.26 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,548.82 / $3,090.30
| Professional | | $354.81 | $1,548.82 | $3,090.30 |