- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $4,365.16 / $10,715.19
| Facility | | $645.65 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 50 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $1,047.13
| Professional | | $398.11 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,454.71 / $11,220.18
| Facility | | $691.83 | $2,454.71 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $616.60
| Professional | | $389.05 | $489.78 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,023.29 / $1,122.02
| Facility | | $512.86 | $1,023.29 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $1,122.02
| Professional | | $363.08 | $588.84 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,309.57 / $11,748.98
| Facility | | $3,467.37 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $676.08
| Professional | | $257.04 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $660.69
| Professional | | $32.36 | $33.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $5,495.41 / $9,772.37
| Facility | | $1,659.59 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $891.25
| Professional | | $354.81 | $501.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $602.56
| Professional | | $346.74 | $446.68 | $602.56 |