- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $4,570.88 / $7,762.47
| Facility | | $181.97 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $251.19
| Professional | | $56.23 | $104.71 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $380.19
| Professional | 50 | $199.53 | $338.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $234.42
| Professional | | $58.88 | $75.86 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,344.23 / $4,168.69
| Facility | | $758.58 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $114.82 / $177.83
| Professional | | $74.13 | $114.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $263.03
| Professional | 50 | $112.20 | $169.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $125.89
| Facility | | $74.13 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $154.88
| Professional | | $104.71 | $134.90 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $645.65
| Facility | | $89.13 | $89.13 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $128.82 / $257.04
| Professional | | $74.13 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $151.36 / $239.88
| Professional | | $70.79 | $151.36 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $19,498.45 / $26,302.68
| Facility | | $7,244.36 | $19,498.45 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $186.21
| Professional | | $91.20 | $165.96 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,995.26 / $3,090.30
| Facility | | $524.81 | $1,995.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $100.00 / $199.53
| Professional | | $54.95 | $100.00 | $199.53 |