- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $4,570.88 / $7,943.28
| Facility | | $630.96 | $4,570.88 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,691.53 / $4,073.80 / $8,317.64
| Facility | 50 | $2,691.53 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $407.38 / $851.14
| Professional | | $269.15 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $501.19 / $912.01 / $2,570.40
| Professional | 50 | $501.19 | $912.01 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $426.58 / $741.31
| Professional | | $128.82 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | 50 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,630.27 / $5,888.44
| Facility | | $1,000.00 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $489.78 / $676.08
| Professional | | $331.13 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $758.58 / $1,023.29
| Professional | 50 | $512.86 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $794.33
| Professional | | $316.23 | $489.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $588.84
| Professional | | $257.04 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $707.95 / $831.76
| Professional | | $575.44 | $707.95 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $3,630.78 / $6,309.57
| Facility | | $1,148.15 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $776.25
| Professional | | $302.00 | $446.68 | $776.25 |