- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $5,011.87 / $12,302.69
| Facility | | $407.38 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.51 / $15,135.61 / $16,218.10
| Facility | 50 | $0.51 | $15,135.61 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $1,071.52
| Professional | | $302.00 | $524.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $354.81 / $812.83 / $2,951.21
| Professional | 50 | $354.81 | $812.83 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $512.86
| Professional | | $208.93 | $389.05 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $4,168.69 / $12,302.69
| Facility | | $380.19 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $575.44
| Professional | | $275.42 | $436.52 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $213.80 / $489.78
| Facility | | $208.93 | $213.80 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $537.03 / $1,000.00
| Professional | | $269.15 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $9,120.11 / $16,982.44
| Facility | | $4,466.84 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $316.23 / $489.78
| Professional | | $295.12 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $512.86
| Professional | | $32.36 | $33.11 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $7,413.10 / $12,302.69
| Facility | | $2,630.27 | $7,413.10 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $512.86 / $1,047.13
| Professional | | $281.84 | $512.86 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $316.23 / $446.68
| Professional | | $204.17 | $316.23 | $446.68 |