- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,630.27 / $8,511.38
| Facility | | $575.44 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,691.53 / $5,754.40 / $8,912.51
| Facility | 50 | $2,691.53 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $363.08 / $524.81
| Professional | | $302.00 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $1,202.26
| Professional | 50 | $446.68 | $446.68 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Professional | 50 | $524.81 | $524.81 | $524.81 |
- 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
- $309.03 / $389.05 / $426.58
| Professional | | $309.03 | $389.05 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $446.68 / $676.08
| Professional | | $208.93 | $446.68 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,691.53 / $8,709.64
| Facility | | $380.19 | $2,691.53 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $6,165.95
| Professional | | $302.00 | $426.58 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $4,677.35 / $9,120.11
| Facility | | $1,230.27 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $562.34
| Professional | | $281.84 | $389.05 | $562.34 |