- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $3,019.95 / $8,317.64
| Facility | | $186.21 | $3,019.95 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $204.17 / $354.81
| Professional | | $128.82 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | 50 | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $346.74
| Professional | | $144.54 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $524.81
| Professional | 50 | $218.78 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $2,511.89
| Professional | | $144.54 | $204.17 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $234.42 / $389.05
| Professional | | $144.54 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $691.83
| Professional | | $123.03 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $309.03 / $524.81
| Professional | | $251.19 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $239.88 / $407.38
| Facility | | $144.54 | $239.88 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $1,659.59
| Facility | | $123.03 | $181.97 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $1,659.59
| Professional | | $194.98 | $288.40 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,047.13 / $2,344.23
| Facility | | $218.78 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $208.93 / $371.54
| Professional | | $120.23 | $208.93 | $371.54 |