- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $4,168.69 / $7,413.10
| Facility | | $363.08 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $4,365.16
| Facility | 50 | $2,630.27 | $2,630.27 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $645.65
| Professional | | $218.78 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $776.25 / $1,288.25
| Professional | 50 | $316.23 | $776.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $691.83
| Professional | | $204.17 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Professional | 50 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,570.40 / $5,888.44
| Facility | | $1,000.00 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $676.08
| Professional | | $257.04 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $1,023.29
| Professional | 50 | $389.05 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $707.95
| Professional | | $257.04 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $371.54 / $489.78
| Professional | | $223.87 | $371.54 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $588.84
| Professional | | $338.84 | $501.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,884.03 / $5,248.07
| Facility | | $1,047.13 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $676.08
| Professional | | $229.09 | $363.08 | $676.08 |