- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $831.76 / $5,495.41
| Facility | | $288.40 | $831.76 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,513.56
| Facility | 50 | $1,122.02 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $457.09 / $1,513.56
| Professional | | $288.40 | $457.09 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $1,047.13 / $4,073.80
| Professional | 50 | $602.56 | $1,047.13 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $1,698.24
| Professional | | $302.00 | $354.81 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | 50 | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,096.48 / $1,819.70
| Professional | | $537.03 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $724.44 / $1,548.82
| Professional | | $346.74 | $724.44 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $457.09 / $1,659.59
| Facility | | $288.40 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $2,238.72
| Facility | | $1,479.11 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $467.74 / $524.81
| Professional | | $426.58 | $467.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,137.96 / $4,265.80
| Facility | | $891.25 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $794.33 / $1,445.44
| Professional | | $295.12 | $794.33 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $3,890.45
| Facility | | $56.23 | $56.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $5,623.41 / $5,623.41
| Professional | | $4,897.79 | $5,623.41 | $5,623.41 |