- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $7,943.28
| Facility | | $371.54 | $707.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,630.27 / $6,165.95 / $12,589.25
| Facility | 50 | $2,630.27 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $407.38 / $933.25
| Professional | | $281.84 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $954.99 / $1,621.81
| Professional | 50 | $426.58 | $954.99 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | 50 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $549.54 / $954.99
| Professional | | $380.19 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $851.14
| Professional | | $346.74 | $512.86 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $660.69
| Facility | | $281.84 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $954.99
| Professional | | $199.53 | $199.53 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $7,079.46 / $10,715.19
| Facility | | $2,187.76 | $7,079.46 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $776.25
| Professional | | $281.84 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,370.32 / $5,370.32
| Facility | | $56.23 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $3,235.94
| Professional | | $2,754.23 | $2,754.23 | $3,235.94 |