- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $4,073.80 / $8,317.64
| Facility | | $724.44 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $3,311.31 / $5,495.41
| Facility | 50 | $2,187.76 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $758.58
| Professional | | $147.91 | $363.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | 50 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $128.82 / $263.03
| Professional | | $61.66 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | 50 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $4,073.80 / $4,570.88
| Facility | | $3,467.37 | $4,073.80 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $645.65
| Professional | | $398.11 | $398.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $794.33
| Professional | | $165.96 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $660.69 / $6,456.54
| Facility | | $199.53 | $660.69 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $4,677.35
| Professional | | $426.58 | $602.56 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,630.27 / $5,754.40
| Facility | | $1,513.56 | $2,630.27 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $645.65
| Professional | | $165.96 | $371.54 | $645.65 |