- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $3,801.89 / $11,481.54
| Facility | | $245.47 | $3,801.89 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $158.49 / $309.03
| Professional | | $53.70 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $162.18 / $446.68
| Professional | 50 | $154.88 | $162.18 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $933.25 / $1,819.70
| Facility | | $724.44 | $933.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $208.93
| Professional | | $63.10 | $107.15 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $323.59
| Professional | | $112.20 | $208.93 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $169.82 / $1,023.29
| Facility | | $63.10 | $169.82 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $218.78 / $1,380.38
| Professional | | $125.89 | $218.78 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $223.87 / $346.74
| Professional | | $117.49 | $223.87 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $169.82 / $346.74
| Professional | | $104.71 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $114.82 / $251.19
| Professional | | $51.29 | $114.82 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,548.82 / $5,248.07
| Facility | | $870.96 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $138.04 / $269.15
| Professional | | $69.18 | $138.04 | $269.15 |