- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $380.19 / $6,606.93
| Facility | | $154.88 | $380.19 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $134.90 / $363.08
| Professional | | $67.61 | $134.90 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | 50 | $154.88 | $154.88 | $154.88 |
- 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
- $109.65 / $199.53 / $371.54
| Professional | | $109.65 | $199.53 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $199.53 / $380.19
| Professional | | $141.25 | $199.53 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $173.78 / $323.59
| Facility | | $83.18 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $363.08
| Professional | | $123.03 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | 50 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $281.84
| Facility | | $158.49 | $263.03 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $169.82 / $316.23
| Facility | | $85.11 | $169.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $190.55 / $363.08
| Professional | | $79.43 | $190.55 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,884.03 / $3,630.78
| Facility | | $2,290.87 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $229.09 / $380.19
| Professional | | $144.54 | $229.09 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,951.21 / $4,897.79
| Facility | | $1,548.82 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $338.84
| Professional | | $109.65 | $190.55 | $338.84 |