- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,071.52 / $4,786.30
| Facility | | $281.84 | $1,071.52 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,019.95 / $3,019.95 / $4,168.69
| Facility | 50 | $3,019.95 | $3,019.95 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $954.99
| Professional | | $269.15 | $371.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $1,621.81 / $2,238.72
| Professional | 50 | $562.34 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $3,311.31 / $6,760.83
| Facility | | $1,698.24 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,467.37 / $5,623.41 / $15,848.93
| Facility | 50 | $3,467.37 | $5,623.41 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $776.25 / $1,380.38
| Professional | | $489.78 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $1,174.90 / $2,089.30
| Professional | 50 | $724.44 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,412.54 / $3,388.44
| Facility | | $1,000.00 | $1,412.54 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,023.29 / $1,659.59
| Professional | | $630.96 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,288.25 / $2,630.27
| Facility | | $1,096.48 | $1,288.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $933.25 / $1,513.56
| Professional | | $575.44 | $933.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $645.65 / $4,786.30
| Facility | | $380.19 | $645.65 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $3,090.30 / $4,677.35
| Facility | 50 | $1,380.38 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $812.83 / $2,137.96
| Professional | | $446.68 | $812.83 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $4,265.80 / $8,912.51
| Facility | | $3,019.95 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $724.44 / $1,348.96
| Professional | | $380.19 | $724.44 | $1,348.96 |