- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $2,290.87 / $7,762.47
| Facility | | $309.03 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $630.96
| Professional | | $223.87 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | 50 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $6,309.57 / $10,232.93
| Facility | | $1,949.84 | $6,309.57 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $512.86
| Professional | | $257.04 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $645.65
| Professional | | $208.93 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $102.33 / $776.25
| Professional | | $32.36 | $102.33 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $426.58 / $602.56
| Facility | | $229.09 | $426.58 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $645.65
| Professional | | $208.93 | $380.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $6,165.95 / $10,471.29
| Facility | | $645.65 | $6,165.95 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $446.68 / $707.95
| Professional | | $269.15 | $446.68 | $707.95 |