- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,412.54 / $5,495.41
| Facility | | $316.23 | $1,412.54 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $446.68
| Professional | | $117.49 | $204.17 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $416.87 / $741.31
| Facility | | $218.78 | $416.87 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $616.60 / $1,071.52
| Facility | 50 | $323.59 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $363.08
| Professional | | $204.17 | $275.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $309.03 / $331.13 / $524.81
| Professional | 50 | $309.03 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $309.03
| Professional | | $123.03 | $204.17 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $575.44
| Facility | | $117.49 | $234.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $380.19
| Professional | | $123.03 | $213.80 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $588.84 / $776.25
| Facility | | $436.52 | $588.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $891.25 / $1,148.15
| Facility | 50 | $660.69 | $891.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $389.05
| Professional | | $177.83 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $588.84
| Professional | | $173.78 | $204.17 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $194.98 / $323.59
| Professional | | $112.20 | $194.98 | $323.59 |