- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $4,570.88 / $7,079.46
| Facility | | $1,023.29 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $831.76 / $3,548.13
| Professional | | $602.56 | $831.76 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $831.76 / $1,548.82 / $5,495.41
| Professional | 50 | $831.76 | $1,548.82 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,412.54 / $2,187.76
| Professional | | $645.65 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $891.25 / $2,089.30
| Professional | | $524.81 | $891.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,819.70 / $6,606.93
| Facility | | $1,023.29 | $1,819.70 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,445.44 / $2,570.40
| Professional | | $812.83 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,995.26
| Professional | 50 | $1,819.70 | $1,819.70 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,548.82 / $1,995.26
| Professional | | $1,148.15 | $1,548.82 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $5,495.41 / $7,585.78
| Facility | | $3,090.30 | $5,495.41 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $1,862.09
| Professional | | $602.56 | $954.99 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,318.26 / $1,621.81
| Professional | | $1,096.48 | $1,318.26 | $1,621.81 |