- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $3,981.07 / $13,489.63
| Facility | | $457.09 | $3,981.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,659.59 / $7,585.78
| Professional | | $295.12 | $1,659.59 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | 50 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $6,456.54 / $9,772.37
| Professional | | $645.65 | $6,456.54 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $3,801.89 / $6,606.93
| Professional | | $281.84 | $3,801.89 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $8,912.51 / $28,183.83
| Facility | | $724.44 | $8,912.51 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $6,918.31 / $12,589.25
| Professional | | $794.33 | $6,918.31 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $7,762.47 / $9,332.54
| Professional | | $724.44 | $7,762.47 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $9,332.54 / $10,964.78
| Professional | | $794.33 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $724.44 / $6,606.93
| Professional | | $302.00 | $724.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,549.93 / $16,218.10 / $30,199.52
| Facility | | $9,549.93 | $16,218.10 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,951.21 / $9,549.93
| Professional | | $346.74 | $2,951.21 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $707.95 / $7,585.78
| Professional | | $602.56 | $707.95 | $7,585.78 |