- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,288.25 / $8,511.38
| Facility | | $141.25 | $1,288.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $537.03 / $1,548.82
| Professional | | $144.54 | $537.03 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $5,495.41
| Professional | 50 | $794.33 | $794.33 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $691.83 / $1,023.29
| Professional | | $134.90 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $1,548.82
| Professional | 50 | $204.17 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $223.87
| Facility | | $134.90 | $186.21 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $229.09
| Professional | | $151.36 | $190.55 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $251.19 / $251.19
| Facility | | $34.67 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,122.02 / $4,168.69
| Professional | | $162.18 | $1,122.02 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,137.96 / $4,168.69
| Facility | | $588.84 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $676.08 / $1,584.89
| Professional | | $144.54 | $676.08 | $1,584.89 |