- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,290.87 / $9,772.37
| Facility | | $549.54 | $2,290.87 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $912.01 / $3,162.28 / $7,079.46
| Facility | 50 | $912.01 | $3,162.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $338.84 / $933.25
| Professional | | $93.33 | $338.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $302.00 / $977.24
| Professional | 50 | $141.25 | $302.00 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $173.78
| Professional | | $85.11 | $134.90 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $269.15
| Professional | 50 | $128.82 | $181.97 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,570.40 / $11,220.18
| Facility | | $776.25 | $2,570.40 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $457.09 / $588.84
| Professional | | $93.33 | $457.09 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $954.99 / $1,148.15
| Facility | | $165.96 | $954.99 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $302.00 / $912.01
| Professional | | $97.72 | $302.00 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,309.57 / $11,748.98
| Facility | | $3,467.37 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $407.38 / $512.86
| Professional | | $380.19 | $407.38 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $660.69
| Professional | | $32.36 | $33.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,511.89 / $5,011.87
| Facility | | $588.84 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $363.08 / $891.25
| Professional | | $95.50 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $436.52 / $575.44
| Professional | | $75.86 | $436.52 | $575.44 |