- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,137.96 / $7,244.36
| Facility | | $812.83 | $2,137.96 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 50 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $794.33 / $1,479.11
| Professional | | $562.34 | $794.33 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $977.24 / $3,090.30
| Professional | 50 | $794.33 | $977.24 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,318.26 / $1,318.26
| Professional | | $575.44 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,737.80
| Professional | 50 | $1,412.54 | $1,412.54 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $707.95 / $1,348.96
| Professional | | $467.74 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,137.96 / $6,918.31
| Facility | | $794.33 | $2,137.96 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $6,456.54
| Facility | 50 | $5,128.61 | $5,128.61 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $851.14 / $1,348.96
| Professional | | $616.60 | $851.14 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $977.24 / $3,090.30
| Professional | 50 | $794.33 | $977.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $954.99
| Professional | | $467.74 | $691.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,073.80 / $7,585.78
| Facility | | $1,905.46 | $4,073.80 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $1,071.52
| Professional | | $602.56 | $776.25 | $1,071.52 |