- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $831.76 / $1,778.28
| Facility | | $50.12 | $831.76 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $275.42 / $588.84
| Professional | | $52.48 | $275.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,258.93 / $3,019.95
| Facility | | $562.34 | $1,258.93 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,584.89 / $2,511.89 / $7,079.46
| Facility | 50 | $1,584.89 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $389.05 / $1,380.38
| Professional | | $95.50 | $389.05 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $3,715.35
| Facility | | $1,071.52 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $602.56 / $1,737.80
| Professional | | $120.23 | $602.56 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $2,818.38
| Facility | | $1,148.15 | $1,445.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $354.81 / $1,513.56
| Professional | | $112.20 | $354.81 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $660.69 / $2,187.76
| Facility | | $79.43 | $660.69 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $831.76 / $1,548.82
| Professional | | $398.11 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $2,137.96 / $3,981.07
| Facility | | $1,023.29 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $389.05 / $1,348.96
| Professional | | $79.43 | $389.05 | $1,348.96 |