- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $851.14 / $8,511.38
| Facility | | $138.04 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $295.12 / $562.34
| Professional | | $128.82 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Professional | 50 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $10,715.19 / $11,220.18
| Facility | | $5,011.87 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $147.91
| Professional | | $97.72 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $169.82 / $223.87
| Professional | 50 | $144.54 | $169.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $181.97 / $234.42
| Facility | | $134.90 | $181.97 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $223.87
| Professional | | $147.91 | $181.97 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $251.19 / $251.19
| Facility | | $34.67 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 52 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $446.68 / $1,778.28
| Professional | | $165.96 | $446.68 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $309.03
| Professional | | $32.36 | $33.11 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $3,388.44 / $6,025.60
| Facility | | $602.56 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $309.03 / $630.96
| Professional | | $147.91 | $309.03 | $630.96 |