- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $5,888.44 / $14,791.08
| Facility | | $295.12 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,248.07 / $9,549.93 / $14,454.40
| Facility | 50 | $5,248.07 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $776.25
| Professional | | $251.19 | $426.58 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $389.05 / $3,890.45
| Professional | 50 | $169.82 | $389.05 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $295.12
| Professional | 50 | $165.96 | $165.96 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $3,890.45 / $9,772.37
| Facility | | $1,348.96 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $436.52 / $676.08
| Professional | | $208.93 | $436.52 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,090.30 / $3,981.07
| Facility | | $575.44 | $3,090.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $851.14
| Professional | | $275.42 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $446.68 / $954.99
| Facility | | $275.42 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $10,232.93 / $20,892.96
| Facility | | $5,248.07 | $10,232.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $691.83
| Professional | | $234.42 | $398.11 | $691.83 |