- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $3,090.30 / $6,456.54
| Facility | | $398.11 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,445.44 / $2,290.87 / $3,981.07
| Facility | 50 | $1,445.44 | $2,290.87 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $389.05 / $741.31
| Professional | | $181.97 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $758.58 / $1,479.11
| Professional | 50 | $478.63 | $758.58 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $436.52
| Professional | | $162.18 | $204.17 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $275.42 / $645.65
| Professional | 50 | $229.09 | $275.42 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,454.71 / $2,454.71
| Facility | | $2,344.23 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $724.44
| Professional | | $371.54 | $371.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $707.95
| Professional | | $229.09 | $407.38 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $602.56 / $4,168.69
| Facility | | $213.80 | $602.56 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $602.56 / $3,235.94
| Professional | | $416.87 | $602.56 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,041.74 / $4,466.84
| Facility | | $1,445.44 | $2,041.74 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $660.69
| Professional | | $239.88 | $407.38 | $660.69 |