- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,047.13 / $9,332.54
| Facility | | $151.36 | $1,047.13 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $812.83 / $1,479.11
| Professional | | $147.91 | $812.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,388.44 / $7,943.28
| Facility | | $1,737.80 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,073.80 / $6,456.54 / $18,620.87
| Facility | 50 | $4,073.80 | $6,456.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $933.25 / $3,162.28
| Professional | | $269.15 | $933.25 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $1,412.54 / $4,786.30
| Professional | 50 | $398.11 | $1,412.54 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $3,548.13 / $8,511.38
| Facility | | $2,511.89 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,023.29 / $3,890.45
| Professional | | $323.59 | $1,023.29 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $3,311.31 / $6,456.54
| Facility | | $2,630.27 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,348.96 / $3,467.37
| Professional | | $323.59 | $1,348.96 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,380.38 / $4,466.84
| Facility | | $199.53 | $1,380.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,187.76 / $5,495.41
| Professional | | $1,230.27 | $2,187.76 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $4,265.80 / $6,309.57
| Facility | | $1,584.89 | $4,265.80 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $954.99 / $3,311.31
| Professional | | $213.80 | $954.99 | $3,311.31 |