- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,288.25 / $2,041.74
| Facility | | $338.84 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $3,162.28
| Facility | 50 | $2,884.03 | $2,884.03 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $380.19 / $630.96
| Professional | | $239.88 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $1,148.15
| Professional | 50 | $234.42 | $416.87 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,309.57 / $6,309.57 / $8,709.64
| Facility | | $6,309.57 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $575.44
| Professional | | $245.47 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $707.95
| Professional | | $263.03 | $436.52 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $199.53 / $398.11
| Professional | | $165.96 | $199.53 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | 50 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,398.83 / $11,481.54
| Facility | | $1,023.29 | $2,398.83 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $676.08
| Professional | | $229.09 | $380.19 | $676.08 |