- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $8,912.51 / $16,595.87
| Facility | | $389.05 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,344.23 / $5,495.41 / $24,547.09
| Facility | 50 | $2,344.23 | $5,495.41 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $870.96
| Professional | | $316.23 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $724.44 / $2,818.38
| Professional | 50 | $512.86 | $724.44 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $4,168.69 / $9,549.93
| Facility | | $1,621.81 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $660.69 / $1,096.48
| Professional | | $263.03 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $3,090.30 / $3,981.07
| Facility | | $812.83 | $3,090.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $707.95
| Professional | | $346.74 | $512.86 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $549.54 / $1,174.90
| Facility | | $331.13 | $549.54 | $1,174.90 |
- 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 / $12,302.69 / $29,512.09
| Facility | | $5,248.07 | $12,302.69 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $776.25
| Professional | | $316.23 | $436.52 | $776.25 |