- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,584.89 / $6,025.60
| Facility | | $398.11 | $1,584.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $4,073.80 / $5,888.44
| Facility | 50 | $2,089.30 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $741.31
| Professional | | $208.93 | $354.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | 50 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 50 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,737.80 / $3,890.45
| Facility | | $1,513.56 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $316.23 / $478.63
| Professional | | $154.88 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $707.95
| Professional | 50 | $229.09 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $831.76
| Professional | | $223.87 | $407.38 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $354.81 / $741.31
| Professional | | $186.21 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $407.38 / $954.99
| Professional | | $218.78 | $407.38 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 50 | $380.19 | $380.19 | $380.19 |