- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $4,466.84 / $12,022.64
| Facility | | $407.38 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,096.48 / $4,365.16 / $5,754.40
| Facility | 50 | $1,096.48 | $4,365.16 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $676.08
| Professional | | $239.88 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $229.09 / $338.84
| Professional | 50 | $169.82 | $229.09 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $199.53
| Professional | | $190.55 | $190.55 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | 50 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $8,128.31 / $8,709.64
| Facility | | $4,466.84 | $8,128.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $870.96
| Professional | | $478.63 | $478.63 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $724.44
| Professional | | $239.88 | $416.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $645.65 / $12,882.50
| Facility | | $302.00 | $645.65 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $4,466.84
| Professional | | $316.23 | $489.78 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,168.69 / $7,943.28
| Facility | | $1,513.56 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $380.19 / $645.65
| Professional | | $263.03 | $380.19 | $645.65 |