- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $6,456.54 / $12,589.25
| Facility | | $389.05 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $295.12 / $933.25
| Professional | | $125.89 | $295.12 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $1,513.56 / $1,513.56
| Professional | 50 | $295.12 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,348.96
| Facility | | $524.81 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $218.78 / $354.81
| Professional | | $138.04 | $218.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $562.34
| Professional | | $181.97 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $288.40 / $1,230.27
| Facility | | $141.25 | $288.40 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $371.54 / $1,412.54
| Professional | | $245.47 | $371.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $537.03
| Professional | | $269.15 | $416.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $416.87
| Professional | | $269.15 | $269.15 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $173.78 / $512.86
| Professional | | $3.98 | $173.78 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,047.13 / $3,801.89
| Facility | | $295.12 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $457.09
| Professional | | $154.88 | $263.03 | $457.09 |