- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $537.03
| Facility | | $295.12 | $501.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 50 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $112.20 / $288.40
| Professional | | $60.26 | $112.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $549.54
| Professional | 50 | $123.03 | $181.97 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46,773.51 / $75,857.76 / $95,499.26
| Facility | | $46,773.51 | $75,857.76 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $158.49
| Professional | | $93.33 | $134.90 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Facility | | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $151.36
| Professional | | $75.86 | $102.33 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $177.83
| Facility | | $100.00 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $177.83
| Professional | | $100.00 | $147.91 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $177.83
| Facility | | $57.54 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $190.55
| Professional | | $79.43 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $169.82
| Professional | | $81.28 | $114.82 | $169.82 |