- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $6,606.93
| Facility | | $288.40 | $501.19 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $478.63
| Professional | | $138.04 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $275.42 / $281.84
| Professional | 50 | $251.19 | $275.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $309.03 / $549.54
| Professional | | $181.97 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $537.03
| Professional | | $239.88 | $354.81 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $288.40 / $501.19
| Facility | | $147.91 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $501.19
| Professional | | $208.93 | $331.13 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $275.42 / $281.84
| Professional | 50 | $251.19 | $275.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $426.58
| Facility | | $251.19 | $398.11 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $288.40 / $501.19
| Facility | | $147.91 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $316.23 / $501.19
| Professional | | $79.43 | $316.23 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,230.27
| Facility | | $724.44 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $1,862.09
| Facility | 50 | $1,071.52 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $588.84
| Professional | | $263.03 | $398.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,380.38 / $5,128.61
| Facility | | $676.08 | $1,380.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $537.03
| Professional | | $208.93 | $323.59 | $537.03 |