- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,370.32 / $7,413.10
| Facility | | $2,041.74 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $1,778.28 / $5,623.41
| Facility | 50 | $1,380.38 | $1,778.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,513.56 / $3,388.44
| Professional | | $141.25 | $1,513.56 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $5,128.61 / $5,370.32
| Professional | 50 | $389.05 | $5,128.61 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $5,011.87 / $11,220.18
| Facility | | $2,041.74 | $5,011.87 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,584.89 / $5,495.41
| Professional | | $208.93 | $1,584.89 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $2,398.83 / $8,511.38
| Professional | 50 | $323.59 | $2,398.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $407.38 / $4,168.69
| Professional | | $173.78 | $407.38 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $1,584.89 / $3,019.95
| Professional | | $125.89 | $1,584.89 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,311.31 / $4,570.88
| Professional | | $2,398.83 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $3,981.07 / $6,918.31
| Facility | | $1,202.26 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,737.80 / $5,248.07
| Professional | | $162.18 | $1,737.80 | $5,248.07 |