- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $2,454.71 / $5,011.87
| Facility | | $263.03 | $2,454.71 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $1,380.38
| Professional | | $173.78 | $288.40 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $1,905.46 / $1,905.46
| Professional | 50 | $1,380.38 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $4,073.80 / $5,888.44
| Facility | | $3,801.89 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $436.52
| Professional | | $199.53 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $309.03 / $363.08 / $407.38
| Professional | 50 | $309.03 | $363.08 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $446.68
| Professional | | $173.78 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $257.04 / $436.52
| Professional | | $3.80 | $257.04 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $213.80 / $389.05
| Professional | | $3.24 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $257.04 / $257.04
| Professional | | $141.25 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,949.84 / $3,630.78
| Facility | | $676.08 | $1,949.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $478.63
| Professional | | $165.96 | $269.15 | $478.63 |