- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $616.60 / $8,511.38
| Facility | | $537.03 | $616.60 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,754.23 / $5,888.44 / $5,888.44
| Facility | 50 | $2,754.23 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $616.60 / $1,202.26
| Professional | | $501.19 | $616.60 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $1,698.24 / $2,137.96
| Professional | 50 | $741.31 | $1,698.24 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,202.26 / $1,445.44
| Professional | | $1,047.13 | $1,202.26 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,584.89 / $1,819.70 / $2,187.76
| Professional | 50 | $1,584.89 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,318.26 / $1,862.09
| Professional | | $933.25 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,659.59
| Facility | | $549.54 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,467.37
| Facility | 50 | $3,235.94 | $3,235.94 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,148.15 / $4,677.35
| Professional | | $616.60 | $1,148.15 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,019.95 / $3,388.44
| Facility | | $2,398.83 | $3,019.95 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $933.25 / $1,479.11
| Professional | | $549.54 | $933.25 | $1,479.11 |