- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $416.87 / $5,128.61
| Facility | | $257.04 | $416.87 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $630.96
| Professional | | $239.88 | $371.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $5,370.32 / $13,182.57
| Facility | | $575.44 | $5,370.32 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $758.58 / $1,445.44
| Professional | | $457.09 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $1,148.15 / $2,187.76
| Professional | 50 | $676.08 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,548.82 / $3,715.35
| Facility | | $1,071.52 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,071.52 / $1,778.28
| Professional | | $575.44 | $1,071.52 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,445.44 / $2,884.03
| Facility | | $1,174.90 | $1,445.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,659.59
| Professional | | $575.44 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $575.44 / $5,888.44
| Facility | | $316.23 | $575.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $870.96 / $2,238.72
| Professional | | $446.68 | $870.96 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $3,801.89 / $7,585.78
| Facility | | $1,621.81 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $707.95 / $1,412.54
| Professional | | $346.74 | $707.95 | $1,412.54 |