- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,677.35 / $8,317.64
| Facility | | $2,137.96 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,691.53 / $5,370.32
| Professional | | $251.19 | $2,691.53 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,888.44 / $14,125.38 / $14,791.08
| Professional | 50 | $5,888.44 | $14,125.38 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | 50 | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $7,244.36 / $13,489.63
| Facility | | $1,659.59 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $1,513.56 / $4,786.30
| Professional | | $208.93 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $2,818.38 / $6,760.83
| Professional | | $263.03 | $2,818.38 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $3,235.94 / $6,165.95
| Facility | | $269.15 | $3,235.94 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $4,570.88 / $11,220.18
| Professional | | $3,388.44 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,570.88 / $7,244.36
| Facility | | $3,311.31 | $4,570.88 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $2,691.53 / $5,623.41
| Professional | | $239.88 | $2,691.53 | $5,623.41 |