- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,388.44 / $6,760.83
| Facility | | $602.56 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.52 / $0.52 / $0.52
| Facility | 50 | $0.52 | $0.52 | $0.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $380.19
| Professional | | $131.83 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $331.13
| Professional | 50 | $87.10 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $398.11 / $457.09
| Professional | | $363.08 | $398.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $870.96
| Professional | | $158.49 | $281.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,479.11 / $6,025.60
| Facility | | $295.12 | $1,479.11 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $2,511.89
| Professional | | $181.97 | $316.23 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $389.05 / $602.56
| Professional | | $346.74 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $416.87 / $489.78
| Professional | | $316.23 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $323.59 / $398.11
| Professional | | $5.01 | $323.59 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $489.78
| Professional | | $162.18 | $263.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $346.74
| Professional | | $295.12 | $295.12 | $346.74 |