- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,778.28 / $2,884.03
| Facility | | $537.03 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $4,073.80
| Facility | 50 | $537.03 | $537.03 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $204.17 / $1,023.29
| Professional | | $102.33 | $204.17 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $338.84 / $1,380.38
| Professional | 50 | $151.36 | $338.84 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46,773.51 / $75,857.76 / $95,499.26
| Facility | | $46,773.51 | $75,857.76 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $302.00
| Professional | | $147.91 | $165.96 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $302.00
| Professional | | $134.90 | $177.83 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $346.74
| Facility | | $177.83 | $316.23 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $346.74
| Professional | | $177.83 | $316.23 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $371.54
| Facility | | $123.03 | $223.87 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $199.53 / $371.54
| Professional | | $79.43 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $354.81
| Professional | | $154.88 | $245.47 | $354.81 |