- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $2,951.21 / $7,413.10
| Facility | | $354.81 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $3,090.30
| Facility | 50 | $1,949.84 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $660.69
| Professional | | $213.80 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $457.09 / $1,023.29
| Professional | 50 | $162.18 | $457.09 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,041.74 / $5,248.07
| Facility | | $676.08 | $2,041.74 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $295.12 / $501.19
| Professional | | $223.87 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $741.31
| Professional | 50 | $338.84 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $398.11
| Professional | | $186.21 | $309.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $616.60
| Professional | | $213.80 | $346.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $870.96 / $16,218.10
| Facility | | $269.15 | $870.96 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $2,290.87
| Professional | | $316.23 | $588.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,318.26 / $2,818.38
| Facility | | $1,071.52 | $1,318.26 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $676.08
| Professional | | $223.87 | $354.81 | $676.08 |