- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,981.07 / $10,232.93
| Facility | | $776.25 | $3,981.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $4,570.88 / $9,549.93
| Facility | 50 | $4,168.69 | $4,570.88 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $870.96 / $3,548.13
| Professional | | $630.96 | $870.96 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $1,445.44 / $4,897.79
| Professional | 50 | $288.40 | $1,445.44 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,025.60 / $7,762.47
| Facility | | $4,466.84 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $977.24 / $1,412.54
| Professional | | $707.95 | $977.24 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,096.48 / $1,288.25 / $1,445.44
| Professional | 50 | $1,096.48 | $1,288.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $912.01 / $1,348.96
| Professional | | $660.69 | $912.01 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $891.25 / $1,445.44
| Professional | | $5.62 | $891.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $912.01 / $1,318.26
| Professional | | $4.79 | $912.01 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $891.25 / $891.25
| Professional | | $602.56 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,344.23 / $7,943.28
| Facility | | $1,258.93 | $2,344.23 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,548.82
| Professional | | $588.84 | $912.01 | $1,548.82 |