- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $5,011.87 / $7,943.28
| Facility | | $199.53 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $302.00 / $933.25
| Professional | | $120.23 | $302.00 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $1,288.25
| Professional | 50 | $478.63 | $478.63 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $354.81 / $660.69
| Professional | | $288.40 | $354.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $389.05 / $1,905.46
| Professional | | $151.36 | $389.05 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $741.31 / $4,897.79
| Facility | | $288.40 | $741.31 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $501.19 / $5,754.40
| Professional | | $269.15 | $501.19 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $489.78 / $616.60
| Professional | | $288.40 | $489.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $616.60
| Professional | | $245.47 | $380.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $426.58 / $1,122.02
| Professional | | $5.01 | $426.58 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $3,890.45 / $6,309.57
| Facility | | $2,238.72 | $3,890.45 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $288.40 / $870.96
| Professional | | $141.25 | $288.40 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $501.19
| Professional | | $234.42 | $275.42 | $501.19 |