- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,995.26 / $4,168.69
| Facility | | $446.68 | $1,995.26 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,162.28 / $8,128.31 / $9,772.37
| Facility | 50 | $3,162.28 | $8,128.31 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $1,000.00
| Professional | | $295.12 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $3,311.31
| Professional | 50 | $1,659.59 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $338.84 / $457.09
| Professional | | $331.13 | $338.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,073.80 / $5,888.44
| Facility | | $1,905.46 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $707.95 / $1,174.90
| Professional | | $389.05 | $707.95 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $630.96 / $1,023.29
| Professional | | $323.59 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $2,951.21 / $2,951.21
| Facility | | $54.95 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,466.84 / $7,585.78
| Facility | | $2,691.53 | $4,466.84 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $630.96 / $1,023.29
| Professional | | $371.54 | $630.96 | $1,023.29 |