- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $3,548.13 / $6,760.83
| Facility | | $144.54 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $446.68 / $1,202.26
| Professional | | $154.88 | $446.68 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Professional | 50 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $309.03 / $3,630.78
| Facility | | $147.91 | $309.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $630.96 / $1,122.02
| Professional | | $354.81 | $630.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $537.03 / $3,801.89
| Facility | | $190.55 | $537.03 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | 50 | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $870.96 / $4,677.35
| Professional | | $363.08 | $870.96 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $363.08 / $1,096.48
| Professional | | $338.84 | $363.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $933.25
| Professional | | $323.59 | $323.59 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $812.83
| Professional | | $257.04 | $616.60 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $7,244.36
| Facility | | $2,691.53 | $2,691.53 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $426.58 / $1,230.27
| Professional | | $199.53 | $426.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $870.96
| Professional | | $295.12 | $363.08 | $870.96 |