- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $3,890.45 / $5,495.41
| Facility | | $1,412.54 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $478.63 / $1,288.25
| Professional | | $100.00 | $478.63 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,288.25 / $5,248.07
| Facility | | $524.81 | $1,288.25 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $1,905.46 / $7,943.28
| Facility | 50 | $776.25 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $575.44 / $1,122.02
| Professional | | $181.97 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $288.40 / $1,698.24
| Professional | 50 | $251.19 | $288.40 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $426.58 / $1,023.29
| Professional | | $125.89 | $426.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $660.69 / $1,995.26
| Facility | | $125.89 | $660.69 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $630.96 / $1,148.15
| Professional | | $114.82 | $630.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,570.88 / $6,456.54
| Facility | | $3,467.37 | $4,570.88 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,248.07 / $7,413.10 / $9,772.37
| Facility | 50 | $5,248.07 | $7,413.10 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $190.55 / $933.25
| Professional | | $147.91 | $190.55 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $524.81 / $3,801.89
| Professional | | $173.78 | $524.81 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,168.69 / $4,466.84
| Facility | | $2,630.27 | $4,168.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $467.74 / $933.25
| Professional | | $112.20 | $467.74 | $933.25 |