- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $912.01 / $5,623.41
| Facility | | $316.23 | $912.01 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $1,412.54
| Professional | | $302.00 | $426.58 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $1,047.13 / $1,174.90
| Professional | 50 | $602.56 | $1,047.13 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $363.08
| Professional | | $177.83 | $309.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $4,265.80 / $8,317.64
| Facility | | $2,089.30 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $1,023.29
| Professional | | $316.23 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $891.25 / $1,548.82
| Professional | 50 | $478.63 | $891.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $302.00 / $380.19
| Facility | | $275.42 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $331.13 / $407.38
| Professional | | $309.03 | $331.13 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $1,659.59
| Facility | | $309.03 | $489.78 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $724.44 / $1,230.27
| Professional | | $309.03 | $724.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,818.38 / $4,265.80
| Facility | | $467.74 | $2,818.38 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $1,202.26
| Professional | | $295.12 | $489.78 | $1,202.26 |