- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $630.96 / $1,621.81
| Facility | | $173.78 | $630.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $125.89 / $380.19
| Professional | | $48.98 | $125.89 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.38 / $125.89 / $691.83
| Professional | 50 | $17.38 | $125.89 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $302.00 / $724.44
| Facility | | $1.00 | $302.00 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $208.93 / $562.34
| Professional | | $89.13 | $208.93 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $309.03 / $851.14
| Professional | 50 | $134.90 | $309.03 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $616.60 / $1,479.11
| Facility | | $380.19 | $616.60 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $204.17 / $588.84
| Professional | | $74.13 | $204.17 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $575.44 / $1,122.02
| Facility | | $457.09 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $263.03 / $602.56
| Professional | | $107.15 | $263.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $177.83 / $512.86
| Facility | | $54.95 | $177.83 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $338.84 / $1,778.28
| Professional | | $151.36 | $338.84 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $724.44
| Professional | 50 | $389.05 | $389.05 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,862.09 / $5,370.32
| Facility | | $380.19 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $346.74 / $1,047.13
| Professional | | $85.11 | $346.74 | $1,047.13 |