- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $4,466.84 / $14,454.40
| Facility | | $575.44 | $4,466.84 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $30,902.95 / $30,902.95 / $42,657.95
| Facility | 50 | $30,902.95 | $30,902.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,023.29 / $7,079.46
| Professional | | $323.59 | $1,023.29 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Professional | 50 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $14,791.08 / $19,952.62
| Facility | | $4,570.88 | $14,791.08 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,548.82 / $6,760.83
| Professional | | $380.19 | $1,548.82 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $17,378.01 / $17,378.01
| Facility | | $8,511.38 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $724.44 / $5,754.40
| Professional | | $363.08 | $724.44 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $4,365.16 / $10,232.93
| Professional | | $346.74 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $389.05 / $4,265.80
| Professional | | $338.84 | $389.05 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $10,471.29 / $25,703.96
| Facility | | $4,073.80 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $2,884.03 / $6,456.54
| Professional | | $354.81 | $2,884.03 | $6,456.54 |