- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $218.78
| Professional | | $95.50 | $151.36 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $407.38 / $758.58
| Facility | | $120.23 | $407.38 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $562.34 / $1,148.15
| Facility | 50 | $181.97 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $208.93
| Professional | | $158.49 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $302.00
| Professional | 50 | $239.88 | $281.84 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $177.83
| Professional | | $81.28 | $141.25 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $616.60
| Facility | | $100.00 | $190.55 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $173.78 / $229.09
| Professional | | $102.33 | $173.78 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $912.01
| Facility | | $524.81 | $724.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $1,380.38
| Facility | 50 | $794.33 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $199.53 / $218.78
| Professional | | $141.25 | $199.53 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $691.83
| Professional | | $89.13 | $147.91 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $8,317.64 / $9,332.54
| Facility | | $181.97 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $199.53
| Professional | | $102.33 | $138.04 | $199.53 |