- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,630.78 / $6,760.83
| Facility | | $1,698.24 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,778.28 / $5,495.41 / $15,848.93
| Facility | 50 | $1,778.28 | $5,495.41 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,071.52 / $2,691.53
| Professional | | $309.03 | $1,071.52 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $1,047.13 / $5,754.40
| Professional | 50 | $346.74 | $1,047.13 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Professional | 50 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $346.74 / $645.65
| Facility | | $79.43 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,584.89 / $3,235.94
| Professional | | $323.59 | $1,584.89 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,230.27 / $2,754.23
| Professional | | $331.13 | $1,230.27 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,659.59 / $6,606.93
| Facility | | $338.84 | $1,659.59 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,290.87 / $12,022.64
| Professional | | $1,445.44 | $2,290.87 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,606.93 / $10,715.19
| Facility | | $4,677.35 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,230.27 / $2,511.89
| Professional | | $316.23 | $1,230.27 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $89.13
| Professional | 50 | $79.43 | $79.43 | $89.13 |