- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $4,570.88 / $12,022.64
| Facility | | $1,202.26 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $3,467.37
| Facility | 50 | $1,621.81 | $1,621.81 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,513.56 / $2,818.38
| Professional | | $151.36 | $1,513.56 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 50 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,709.64 / $8,709.64
| Facility | | $8,128.31 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $3,235.94
| Professional | | $281.84 | $281.84 | $3,235.94 |
- 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
- $165.96 / $1,584.89 / $3,311.31
| Professional | | $165.96 | $1,584.89 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,290.87 / $5,888.44
| Facility | | $199.53 | $2,290.87 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,691.53 / $12,022.64
| Professional | | $1,862.09 | $2,691.53 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $5,011.87 / $7,943.28
| Facility | | $1,905.46 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,548.82 / $2,884.03
| Professional | | $177.83 | $1,548.82 | $2,884.03 |