- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,897.79 / $8,128.31
| Facility | | $1,513.56 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,202.26 / $2,570.40
| Professional | | $309.03 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $1,380.38 / $9,120.11
| Professional | 50 | $398.11 | $1,380.38 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,047.13 / $1,348.96
| Professional | | $269.15 | $1,047.13 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $436.52 / $1,621.81
| Professional | | $81.28 | $436.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $741.31 / $2,454.71
| Professional | 50 | $645.65 | $741.31 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $741.31 / $1,905.46
| Professional | | $288.40 | $741.31 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,897.79 / $8,128.31
| Facility | | $1,905.46 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,318.26 / $2,570.40
| Professional | | $346.74 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $741.31 / $9,120.11
| Professional | 50 | $398.11 | $741.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $741.31 / $1,905.46
| Professional | | $288.40 | $741.31 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $5,495.41 / $9,120.11
| Facility | | $2,511.89 | $5,495.41 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,174.90 / $2,570.40
| Professional | | $346.74 | $1,174.90 | $2,570.40 |