- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $575.44 / $575.44
| Facility | | $186.21 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $478.63 / $794.33
| Professional | | $177.83 | $478.63 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | 50 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $6,918.31 / $16,982.44
| Facility | | $1,071.52 | $6,918.31 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $8,709.64 / $13,803.84 / $39,810.72
| Facility | 50 | $8,709.64 | $13,803.84 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $724.44 / $1,778.28
| Professional | | $323.59 | $724.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $1,096.48 / $2,691.53
| Professional | 50 | $489.78 | $1,096.48 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,995.26 / $4,677.35
| Facility | | $1,230.27 | $1,995.26 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $891.25 / $2,187.76
| Professional | | $389.05 | $891.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,819.70 / $3,630.78
| Facility | | $1,479.11 | $1,819.70 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $870.96 / $1,995.26
| Professional | | $389.05 | $870.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $776.25 / $7,762.47
| Facility | | $239.88 | $776.25 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,122.02 / $2,818.38
| Professional | | $602.56 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,888.44 / $9,549.93
| Facility | | $1,584.89 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $691.83 / $1,778.28
| Professional | | $263.03 | $691.83 | $1,778.28 |