- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $6,606.93 / $16,595.87
| Facility | | $831.76 | $6,606.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $691.83 / $1,621.81
| Professional | | $295.12 | $691.83 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $1,000.00 / $2,398.83
| Professional | 50 | $426.58 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $281.84 / $426.58
| Professional | | $263.03 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $426.58
| Professional | 50 | $416.87 | $416.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $12,022.64 / $26,302.68
| Facility | | $2,630.27 | $12,022.64 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $1,000.00
| Professional | | $275.42 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $8,128.31
| Facility | | $891.25 | $891.25 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $812.83 / $1,737.80
| Professional | | $363.08 | $812.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $741.31 / $1,778.28
| Facility | | $338.84 | $741.31 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $16,595.87 / $46,773.51
| Facility | | $4,677.35 | $16,595.87 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $616.60 / $1,513.56
| Professional | | $275.42 | $616.60 | $1,513.56 |