- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $2,089.30 / $7,762.47
| Facility | | $125.89 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $120.23 / $275.42
| Professional | | $57.54 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $208.93
| Professional | 50 | $134.90 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $173.78 / $181.97
| Professional | | $144.54 | $173.78 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $162.18 / $263.03
| Professional | | $154.88 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $245.47 / $398.11
| Professional | 50 | $234.42 | $245.47 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $257.04
| Professional | | $67.61 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $380.19
| Professional | | $223.87 | $309.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $208.93 / $309.03
| Professional | | $114.82 | $208.93 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,230.27 / $3,090.30
| Facility | | $831.76 | $1,230.27 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $162.18 / $181.97
| Professional | | $144.54 | $162.18 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $1,412.54 / $6,165.95
| Facility | | $93.33 | $1,412.54 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $309.03
| Professional | | $58.88 | $128.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $190.55 / $354.81
| Professional | | $30.20 | $190.55 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $257.04 / $575.44
| Facility | | $64.57 | $257.04 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $309.03
| Professional | | $60.26 | $109.65 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,949.84 / $3,890.45
| Facility | | $575.44 | $1,949.84 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $120.23 / $234.42
| Professional | | $58.88 | $120.23 | $234.42 |