- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $3,090.30 / $6,760.83
| Facility | | $218.78 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $645.65
| Professional | | $144.54 | $269.15 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,344.23
| Professional | 50 | $2,137.96 | $2,137.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $426.58 / $851.14
| Professional | | $338.84 | $426.58 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $416.87 / $891.25
| Professional | | $151.36 | $416.87 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $741.31 / $5,248.07
| Facility | | $323.59 | $741.31 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $1,096.48
| Professional | | $323.59 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $776.25
| Professional | | $338.84 | $602.56 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $457.09 / $776.25
| Professional | | $389.05 | $457.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $758.58
| Professional | | $6.03 | $6.03 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $4,466.84 / $6,309.57
| Facility | | $2,570.40 | $4,466.84 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $331.13 / $707.95
| Professional | | $169.82 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $616.60
| Professional | | $275.42 | $323.59 | $616.60 |