- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $602.56 / $6,606.93
| Facility | | $190.55 | $602.56 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $199.53 / $575.44
| Professional | | $77.62 | $199.53 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 50 | $229.09 | $229.09 | $229.09 |
- 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
- $123.03 / $223.87 / $588.84
| Professional | | $123.03 | $223.87 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $239.88 / $602.56
| Professional | | $154.88 | $239.88 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $218.78 / $489.78
| Facility | | $93.33 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $302.00 / $537.03
| Professional | | $134.90 | $302.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 50 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $446.68
| Facility | | $213.80 | $407.38 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $213.80 / $478.63
| Facility | | $93.33 | $213.80 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $218.78 / $549.54
| Professional | | $79.43 | $218.78 | $549.54 |
- 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
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,388.44 / $4,365.16 / $5,495.41
| Facility | 50 | $3,388.44 | $4,365.16 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $602.56
| Professional | | $158.49 | $281.84 | $602.56 |
- 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
- $120.23 / $245.47 / $512.86
| Professional | | $120.23 | $245.47 | $512.86 |