- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $5,011.87 / $13,489.63
| Facility | | $2,344.23 | $5,011.87 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,122.02 / $2,041.74
| Professional | | $269.15 | $1,122.02 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 50 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $14,454.40 / $28,183.83
| Facility | | $11,220.18 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $588.84 / $2,238.72
| Professional | | $263.03 | $588.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,096.48 / $3,548.13
| Professional | | $426.58 | $1,096.48 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,905.46 / $3,890.45
| Facility | | $354.81 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $8,912.51
| Professional | | $1,288.25 | $2,511.89 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $501.19 / $2,137.96 / $2,137.96
| Professional | 50 | $501.19 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $2,238.72 / $3,467.37
| Professional | | $616.60 | $2,238.72 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $870.96 / $3,890.45
| Professional | | $588.84 | $870.96 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $7,585.78
| Facility | | $2,630.27 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,288.25 / $2,884.03
| Professional | | $371.54 | $1,288.25 | $2,884.03 |