- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $977.24 / $6,606.93
| Facility | | $93.33 | $977.24 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $346.74 / $870.96
| Professional | | $93.33 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $323.59 / $323.59
| Professional | 50 | $141.25 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,570.88 / $9,332.54
| Facility | | $2,691.53 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $7,762.47 / $21,877.62
| Facility | 50 | $4,786.30 | $7,762.47 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $691.83 / $2,041.74
| Professional | | $177.83 | $691.83 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $263.03 / $1,047.13 / $3,019.95
| Professional | 50 | $263.03 | $1,047.13 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $5,370.32
| Facility | | $1,412.54 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $676.08 / $2,511.89
| Professional | | $218.78 | $676.08 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,089.30 / $4,073.80
| Facility | | $1,698.24 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $851.14 / $2,187.76
| Professional | | $213.80 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,047.13 / $3,981.07
| Facility | | $147.91 | $1,047.13 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,041.74 / $4,466.84 / $5,011.87
| Facility | 50 | $2,041.74 | $4,466.84 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,230.27 / $2,344.23
| Professional | | $630.96 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,311.31 / $6,165.95
| Facility | | $1,584.89 | $3,311.31 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $562.34 / $1,949.84
| Professional | | $144.54 | $562.34 | $1,949.84 |