- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $977.24 / $2,089.30
| Facility | | $177.83 | $977.24 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $213.80 / $562.34
| Professional | | $77.62 | $213.80 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $229.09
| Professional | 50 | $128.82 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $446.68
| Professional | | $123.03 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $676.08
| Professional | 50 | $186.21 | $295.12 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $741.31 / $1,174.90
| Facility | | $630.96 | $741.31 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $363.08 / $977.24
| Professional | | $134.90 | $363.08 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $234.42 / $3,162.28
| Facility | | $81.28 | $234.42 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $616.60
| Professional | | $158.49 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $407.38 / $912.01
| Professional | 50 | $234.42 | $407.38 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $239.88 / $3,630.78
| Facility | | $81.28 | $239.88 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $1,995.26
| Professional | | $208.93 | $380.19 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $107.15
| Professional | | $32.36 | $33.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $2,951.21 / $3,235.94
| Facility | | $162.18 | $2,951.21 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $371.54 / $758.58
| Professional | | $173.78 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $794.33
| Professional | | $147.91 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,819.70 / $2,691.53
| Facility | | $977.24 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,047.13 / $1,995.26
| Professional | | $162.18 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $831.76
| Professional | | $295.12 | $295.12 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $549.54 / $1,348.96
| Professional | | $234.42 | $549.54 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,754.23 / $5,011.87
| Facility | | $2,238.72 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $239.88 / $691.83
| Professional | | $89.13 | $239.88 | $691.83 |