- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $891.25 / $3,235.94
| Facility | | $123.03 | $891.25 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $141.25 / $389.05
| Professional | | $48.98 | $141.25 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.38 / $169.82 / $691.83
| Professional | 50 | $17.38 | $169.82 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,000.00 / $2,951.21
| Facility | | $56.23 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $162.18 / $1,862.09
| Professional | | $52.48 | $162.18 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $131.83
| Facility | | $56.23 | $56.23 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $194.98 / $436.52
| Professional | | $56.23 | $194.98 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $177.83 / $398.11
| Professional | | $63.10 | $177.83 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $3,311.31
| Facility | | $46.77 | $61.66 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $229.09 / $371.54
| Professional | | $181.97 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $162.18 / $398.11
| Professional | | $51.29 | $162.18 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $316.23 / $758.58
| Facility | | $114.82 | $316.23 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $398.11
| Professional | | $69.18 | $91.20 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,000.00 / $2,951.21
| Facility | | $56.23 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $162.18 / $1,862.09
| Professional | | $52.48 | $162.18 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $162.18 / $416.87
| Professional | | $56.23 | $162.18 | $416.87 |