- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,862.09 / $5,248.07
| Facility | | $416.87 | $1,862.09 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 50 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $446.68 / $1,513.56
| Professional | | $173.78 | $446.68 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $870.96 / $1,288.25
| Professional | 50 | $302.00 | $870.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $549.54 / $2,290.87
| Professional | | $269.15 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $2,041.74
| Professional | | $288.40 | $436.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,148.15 / $2,818.38
| Facility | | $229.09 | $1,148.15 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 50 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $954.99 / $2,137.96
| Professional | | $251.19 | $954.99 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $870.96 / $1,288.25
| Professional | 50 | $302.00 | $870.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,548.82 / $1,698.24
| Facility | | $1,000.00 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $870.96 / $2,137.96
| Facility | | $229.09 | $870.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $436.52 / $2,187.76
| Professional | | $79.43 | $436.52 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $575.44 / $2,454.71
| Professional | | $346.74 | $575.44 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $4,073.80 / $6,165.95
| Facility | | $389.05 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $758.58 / $2,187.76
| Professional | | $269.15 | $758.58 | $2,187.76 |