- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $3,715.35 / $7,585.78
| Facility | | $331.13 | $3,715.35 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $3,235.94 / $8,128.31
| Facility | 50 | $1,862.09 | $3,235.94 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $758.58
| Professional | | $245.47 | $346.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $446.68 / $870.96
| Professional | | $323.59 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $758.58
| Professional | | $288.40 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $575.44
| Facility | | $251.19 | $363.08 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $891.25
| Professional | | $223.87 | $223.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $398.11 / $524.81
| Professional | | $363.08 | $398.11 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $7,244.36 / $10,715.19
| Facility | | $3,090.30 | $7,244.36 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $645.65
| Professional | | $245.47 | $338.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $8,912.51 / $28,840.32
| Facility | | $8,912.51 | $8,912.51 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,884.03
| Professional | | $2,398.83 | $2,398.83 | $2,884.03 |