- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $724.44 / $6,606.93
| Facility | | $131.83 | $724.44 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $181.97 / $616.60
| Professional | | $66.07 | $181.97 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $831.76
| Professional | | $89.13 | $190.55 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $776.25
| Professional | | $114.82 | $173.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $165.96 / $676.08
| Facility | | $67.61 | $165.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $234.42 / $812.83
| Professional | | $102.33 | $234.42 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $616.60
| Facility | | $295.12 | $562.34 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $162.18 / $630.96
| Facility | | $66.07 | $162.18 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $194.98 / $870.96
| Professional | | $95.50 | $194.98 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,187.76 / $2,691.53
| Facility | | $1,584.89 | $2,187.76 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,344.23 / $3,311.31 / $4,073.80
| Facility | 50 | $2,344.23 | $3,311.31 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $281.84 / $851.14
| Professional | | $123.03 | $281.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,630.27 / $4,897.79
| Facility | | $1,548.82 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $208.93 / $645.65
| Professional | | $83.18 | $208.93 | $645.65 |