- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $7,943.28
| Facility | | $295.12 | $645.65 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $645.65
| Professional | | $144.54 | $275.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | 50 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $389.05 / $776.25
| Professional | | $239.88 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $707.95
| Professional | | $245.47 | $389.05 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $380.19 / $724.44
| Facility | | $194.98 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $741.31
| Professional | | $218.78 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | 50 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $524.81 / $562.34
| Facility | | $316.23 | $524.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $676.08
| Facility | | $181.97 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $389.05 / $758.58
| Professional | | $79.43 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $5,623.41 / $6,918.31
| Facility | | $4,073.80 | $5,623.41 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,025.60 / $8,511.38 / $10,232.93
| Facility | 50 | $6,025.60 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $776.25
| Professional | | $288.40 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $5,495.41 / $7,762.47
| Facility | | $2,454.71 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $741.31
| Professional | | $218.78 | $398.11 | $741.31 |