- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $3,630.78 / $7,413.10
| Facility | | $169.82 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $416.87
| Professional | | $117.49 | $181.97 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $446.68 / $630.96
| Professional | 50 | $208.93 | $446.68 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $257.04
| Professional | | $125.89 | $144.54 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $467.74
| Professional | 50 | $338.84 | $380.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,344.23 / $4,168.69
| Facility | | $758.58 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $245.47
| Professional | | $100.00 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $154.88 / $234.42 / $380.19
| Professional | 50 | $154.88 | $234.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $162.18
| Facility | | $109.65 | $141.25 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $186.21
| Professional | | $177.83 | $177.83 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $114.82 / $125.89
| Facility | | $91.20 | $114.82 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $331.13
| Professional | | $123.03 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $478.63
| Professional | | $120.23 | $190.55 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $331.13
| Professional | | $144.54 | $186.21 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,258.93 / $2,344.23
| Facility | | $151.36 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $169.82 / $295.12
| Professional | | $120.23 | $169.82 | $295.12 |