- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $446.68 / $6,606.93
| Facility | | $147.91 | $446.68 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $199.53 / $549.54
| Professional | | $91.20 | $199.53 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $269.15 / $1,122.02 / $1,288.25
| Professional | 50 | $269.15 | $1,122.02 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $239.88 / $537.03
| Professional | | $120.23 | $239.88 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $501.19
| Professional | | $123.03 | $186.21 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $275.42 / $489.78
| Facility | | $97.72 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $257.04 / $512.86
| Professional | | $117.49 | $257.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $269.15 / $1,071.52 / $1,288.25
| Professional | 50 | $269.15 | $1,071.52 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $389.05
| Facility | | $223.87 | $363.08 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $269.15 / $467.74
| Facility | | $97.72 | $269.15 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $199.53 / $537.03
| Professional | | $79.43 | $199.53 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,258.93 / $1,621.81
| Facility | | $891.25 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,348.96 / $1,905.46 / $2,398.83
| Facility | 50 | $1,348.96 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $257.04 / $602.56
| Professional | | $151.36 | $257.04 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,778.28 / $5,128.61
| Facility | | $676.08 | $1,778.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $223.87 / $524.81
| Professional | | $131.83 | $223.87 | $524.81 |