- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $3,890.45 / $12,589.25
| Facility | | $630.96 | $3,890.45 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | 50 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,047.13 / $2,691.53
| Professional | | $302.00 | $1,047.13 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $489.78 / $2,344.23
| Professional | 50 | $165.96 | $489.78 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Professional | 50 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,964.78 / $13,803.84 / $28,183.83
| Facility | | $10,964.78 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $676.08 / $3,019.95
| Professional | | $295.12 | $676.08 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,445.44 / $4,897.79
| Professional | | $457.09 | $1,445.44 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,344.23 / $7,943.28
| Facility | | $407.38 | $2,344.23 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 50 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,162.28 / $12,022.64
| Professional | | $1,659.59 | $3,162.28 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,019.95 / $4,365.16
| Professional | | $707.95 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $977.24 / $5,128.61
| Professional | | $676.08 | $977.24 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,244.36 / $9,332.54
| Facility | | $4,570.88 | $7,244.36 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,659.59 / $3,715.35
| Professional | | $416.87 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |