- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,344.23 / $4,897.79
| Facility | | $208.93 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $309.03 / $1,698.24 / $5,623.41
| Facility | 50 | $309.03 | $1,698.24 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $954.99 / $2,818.38
| Professional | | $177.83 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,715.35 / $5,754.40 / $5,754.40
| Professional | 50 | $3,715.35 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | 50 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $25,703.96 / $35,481.34
| Facility | | $10,471.29 | $25,703.96 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $1,230.27 / $7,079.46
| Professional | | $169.82 | $1,230.27 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $257.04 / $1,819.70 / $10,715.19
| Professional | 50 | $257.04 | $1,819.70 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $177.83 / $204.17
| Facility | | $173.78 | $177.83 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $4,168.69
| Facility | | $181.97 | $316.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $741.31 / $5,011.87
| Professional | | $186.21 | $741.31 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,762.47 / $10,964.78
| Facility | | $4,073.80 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,380.38 / $4,677.35
| Professional | | $177.83 | $1,380.38 | $4,677.35 |