- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $251.19 / $2,951.21
| Facility | | $89.13 | $251.19 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $208.93 / $575.44
| Professional | | $85.11 | $208.93 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,258.93 / $2,818.38
| Facility | | $794.33 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,445.44 / $2,344.23 / $6,606.93
| Facility | 50 | $1,445.44 | $2,344.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $338.84 / $794.33
| Professional | | $158.49 | $338.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $870.96 / $2,089.30
| Facility | | $602.56 | $870.96 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $426.58 / $977.24
| Professional | | $190.55 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $831.76 / $1,621.81
| Facility | | $660.69 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $389.05 / $851.14
| Professional | | $186.21 | $389.05 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $363.08 / $2,951.21
| Facility | | $117.49 | $363.08 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $1,621.81
| Professional | | $263.03 | $537.03 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,238.72 / $5,370.32
| Facility | | $1,584.89 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $309.03 / $812.83
| Professional | | $128.82 | $309.03 | $812.83 |