- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $208.93 / $6,606.93
| Facility | | $93.33 | $208.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $85.11 / $223.87
| Professional | | $42.66 | $85.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $239.88 / $354.81
| Professional | 50 | $100.00 | $239.88 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $208.93
| Professional | | $64.57 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $213.80
| Professional | | $77.62 | $120.23 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $181.97
| Facility | | $57.54 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $208.93
| Professional | | $67.61 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $338.84
| Professional | 50 | $100.00 | $151.36 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $162.18
| Facility | | $97.72 | $154.88 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $173.78
| Facility | | $57.54 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $208.93
| Professional | | $79.43 | $117.49 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,023.29 / $1,174.90
| Facility | | $741.31 | $1,023.29 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $1,737.80
| Facility | 50 | $1,096.48 | $1,548.82 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $218.78
| Professional | | $87.10 | $134.90 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,318.26 / $5,128.61
| Facility | | $676.08 | $1,318.26 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $186.21
| Professional | | $66.07 | $112.20 | $186.21 |