- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $5,011.87 / $25,703.96
| Facility | | $380.19 | $5,011.87 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | 50 | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $3,467.37 / $6,760.83
| Professional | | $331.13 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28,183.83 / $38,904.51 / $38,904.51
| Facility | | $28,183.83 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,047.13 / $5,248.07
| Professional | | $316.23 | $1,047.13 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $1,548.82 / $7,943.28
| Professional | 50 | $478.63 | $1,548.82 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $7,585.78 / $10,000.00
| Professional | | $346.74 | $7,585.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $831.76 / $6,025.60
| Professional | | $346.74 | $831.76 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $3,890.45 / $4,786.30
| Professional | | $257.04 | $3,890.45 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $9,120.11 / $9,120.11
| Professional | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,235.94 / $6,760.83
| Facility | | $346.74 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $26,915.35
| Facility | | $281.84 | $436.52 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $5,370.32 / $26,915.35
| Professional | | $3,311.31 | $5,370.32 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,715.19 / $19,054.61 / $31,622.78
| Facility | | $10,715.19 | $19,054.61 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $2,089.30 / $6,918.31
| Professional | | $309.03 | $2,089.30 | $6,918.31 |