- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $3,090.30 / $8,511.38
| Facility | | $724.44 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,041.74 / $7,079.46 / $7,079.46
| Facility | 50 | $2,041.74 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $707.95 / $1,584.89
| Professional | | $446.68 | $707.95 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $1,778.28 / $4,168.69
| Professional | 50 | $316.23 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,548.13 / $9,549.93
| Facility | | $2,951.21 | $3,548.13 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $812.83 / $1,122.02
| Professional | | $524.81 | $812.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $1,148.15
| Professional | | $478.63 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $870.96 / $2,398.83
| Professional | | $467.74 | $870.96 | $2,398.83 |
- 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
- $549.54 / $549.54 / $831.76
| Professional | | $549.54 | $549.54 | $831.76 |
- 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
- $2,041.74 / $3,467.37 / $6,309.57
| Facility | | $2,041.74 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $691.83 / $1,148.15
| Professional | | $446.68 | $691.83 | $1,148.15 |