- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $186.21 / $6,606.93
| Facility | | $87.10 | $186.21 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $95.50 / $229.09
| Professional | | $42.66 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $331.13 / $645.65
| Professional | 50 | $125.89 | $331.13 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $218.78
| Professional | | $70.79 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $199.53
| Professional | | $75.86 | $117.49 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $218.78
| Facility | | $58.88 | $128.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $147.91 / $218.78
| Professional | | $72.44 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $645.65
| Professional | 50 | $125.89 | $125.89 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $208.93
| Facility | | $125.89 | $158.49 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $117.49 / $218.78
| Facility | | $58.88 | $117.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $138.04 / $218.78
| Professional | | $79.43 | $138.04 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,174.90
| Facility | | $741.31 | $1,023.29 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $1,737.80
| Facility | 50 | $1,096.48 | $1,548.82 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $234.42
| Professional | | $87.10 | $151.36 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,318.26 / $5,128.61
| Facility | | $676.08 | $1,318.26 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $208.93
| Professional | | $66.07 | $120.23 | $208.93 |