- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,884.03 / $8,511.38
| Facility | | $512.86 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,019.95 / $6,309.57 / $21,379.62
| Facility | 50 | $3,019.95 | $6,309.57 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $562.34 / $1,122.02
| Professional | | $389.05 | $562.34 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $467.74 / $501.19
| Professional | | $416.87 | $467.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $7,244.36
| Facility | | $5,248.07 | $5,248.07 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $602.56
| Professional | | $457.09 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $549.54 / $758.58
| Facility | | $446.68 | $549.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $1,000.00
| Professional | | $398.11 | $562.34 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $4,677.35
| Facility | | $512.86 | $691.83 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $575.44 / $794.33
| Professional | | $407.38 | $575.44 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $741.31 / $812.83
| Professional | | $524.81 | $741.31 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $5,495.41 / $11,748.98
| Facility | | $1,995.26 | $5,495.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $501.19 / $794.33
| Professional | | $371.54 | $501.19 | $794.33 |