- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,691.53 / $8,317.64
| Facility | | $724.44 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $812.83
| Professional | | $245.47 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $724.44 / $1,230.27
| Professional | 50 | $302.00 | $724.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $426.58 / $758.58
| Professional | | $416.87 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $1,148.15
| Professional | 50 | $616.60 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $741.31
| Professional | | $229.09 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $741.31
| Professional | | $537.03 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $467.74 / $724.44
| Professional | | $263.03 | $467.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $776.25
| Facility | | $407.38 | $407.38 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $562.34
| Professional | | $302.00 | $501.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | 50 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,995.26 / $7,244.36
| Facility | | $537.03 | $1,995.26 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $660.69
| Professional | | $239.88 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $616.60 / $1,023.29
| Professional | | $588.84 | $616.60 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $933.25
| Facility | | $245.47 | $416.87 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $933.25
| Professional | | $245.47 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $758.58 / $3,890.45
| Facility | | $363.08 | $758.58 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $676.08
| Professional | | $229.09 | $398.11 | $676.08 |