- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $457.09 / $13,182.57
| Facility | | $263.03 | $457.09 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $218.78 / $741.31
| Professional | | $123.03 | $218.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $616.60 / $1,479.11
| Professional | 50 | $295.12 | $616.60 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $346.74 / $549.54
| Professional | | $194.98 | $346.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $501.19
| Professional | | $229.09 | $346.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $501.19
| Facility | | $173.78 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $524.81
| Professional | | $199.53 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $616.60 / $1,479.11
| Professional | 50 | $295.12 | $616.60 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $398.11
| Facility | | $223.87 | $380.19 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $489.78
| Facility | | $169.82 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $331.13 / $512.86
| Professional | | $79.43 | $331.13 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,737.80 / $2,041.74
| Facility | | $1,258.93 | $1,737.80 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $2,570.40 / $3,090.30
| Facility | 50 | $1,862.09 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $549.54
| Professional | | $257.04 | $389.05 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,344.23 / $5,128.61
| Facility | | $676.08 | $2,344.23 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $524.81
| Professional | | $190.55 | $331.13 | $524.81 |