- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,000.00 / $7,762.47
| Facility | | $660.69 | $1,000.00 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 50 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $758.58 / $1,258.93
| Professional | | $524.81 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $724.44 / $1,380.38
| Professional | 50 | $630.96 | $724.44 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $9,332.54 / $14,791.08
| Facility | | $2,754.23 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $707.95 / $912.01
| Professional | | $537.03 | $707.95 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $724.44 / $1,071.52
| Professional | | $398.11 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $109.65 / $912.01
| Professional | | $32.36 | $109.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,023.29
| Facility | | $501.19 | $676.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $724.44 / $977.24
| Professional | | $398.11 | $724.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $6,165.95 / $10,471.29
| Facility | | $645.65 | $6,165.95 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,096.48
| Professional | | $537.03 | $776.25 | $1,096.48 |