- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $2,454.71
| Facility | | $229.09 | $446.68 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 50 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $134.90 / $346.74
| Professional | | $47.86 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $691.83
| Professional | 50 | $478.63 | $478.63 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64,565.42 / $77,624.71 / $95,499.26
| Facility | | $64,565.42 | $77,624.71 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $257.04
| Professional | | $77.62 | $77.62 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $309.03
| Facility | | $77.62 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $147.91 / $371.54
| Professional | | $58.88 | $147.91 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $288.40
| Facility | | $83.18 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $288.40
| Professional | | $83.18 | $190.55 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $138.04 / $338.84
| Facility | | $51.29 | $138.04 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $131.83 / $457.09
| Professional | | $77.62 | $131.83 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $162.18 / $323.59
| Professional | | $74.13 | $162.18 | $323.59 |