- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,398.83 / $7,079.46
| Facility | | $489.78 | $2,398.83 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $6,025.60 / $9,549.93
| Facility | 50 | $2,137.96 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $398.11 / $676.08
| Professional | | $223.87 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $177.83 / $398.11
| Professional | 50 | $173.78 | $177.83 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $11,220.18 / $17,782.79
| Facility | | $7,079.46 | $11,220.18 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $562.34
| Professional | | $288.40 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $537.03
| Professional | | $239.88 | $363.08 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $891.25 / $5,888.44
| Facility | | $288.40 | $891.25 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | 50 | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $457.09 / $4,466.84
| Professional | | $288.40 | $457.09 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,388.44 / $6,918.31
| Facility | | $891.25 | $3,388.44 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $588.84
| Professional | | $218.78 | $338.84 | $588.84 |