- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,819.70 / $7,585.78
| Facility | | $389.05 | $1,819.70 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | 50 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $478.63 / $1,412.54
| Professional | | $199.53 | $478.63 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $3,019.95 / $4,786.30
| Facility | | $1,412.54 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $724.44 / $1,698.24
| Professional | | $239.88 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $489.78 / $1,445.44
| Professional | | $234.42 | $489.78 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,202.26 / $2,570.40
| Professional | | $263.03 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $251.19 / $1,148.15
| Professional | | $239.88 | $251.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,388.44 / $6,165.95
| Facility | | $1,778.28 | $3,388.44 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $776.25 / $1,584.89
| Professional | | $229.09 | $776.25 | $1,584.89 |