- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,737.80 / $12,589.25
| Facility | | $323.59 | $1,737.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $741.31 / $2,344.23
| Professional | | $288.40 | $741.31 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $537.03 / $1,513.56
| Professional | 50 | $117.49 | $537.03 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $7,413.10 / $14,454.40
| Facility | | $4,168.69 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $7,413.10 / $12,022.64 / $33,884.42
| Facility | 50 | $7,413.10 | $12,022.64 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,995.26 / $5,623.41
| Professional | | $588.84 | $1,995.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $2,884.03 / $8,511.38
| Professional | 50 | $891.25 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $5,888.44 / $14,125.38
| Facility | | $4,168.69 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,479.11 / $5,888.44
| Professional | | $457.09 | $1,479.11 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $5,623.41 / $10,964.78
| Facility | | $4,570.88 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $2,041.74 / $5,623.41
| Professional | | $645.65 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,737.80 / $4,168.69
| Facility | | $407.38 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,019.95 / $11,481.54
| Professional | | $1,584.89 | $3,019.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,495.41 / $10,715.19
| Facility | | $1,584.89 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,584.89 / $4,677.35
| Professional | | $363.08 | $1,584.89 | $4,677.35 |