- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $794.33 / $5,248.07
| Facility | | $93.33 | $794.33 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $257.04
| Professional | | $48.98 | $112.20 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $562.34 / $776.25
| Professional | 50 | $125.89 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $112.20
| Professional | | $46.77 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $165.96
| Professional | 50 | $70.79 | $97.72 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $912.01
| Professional | | $47.86 | $58.88 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $138.04 / $309.03
| Professional | | $53.70 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $186.21 / $245.47
| Professional | | $154.88 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $257.04 / $389.05
| Professional | | $208.93 | $257.04 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $138.04 / $281.84
| Facility | | $51.29 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $1,258.93
| Facility | | $48.98 | $67.61 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $1,258.93
| Professional | | $134.90 | $208.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,000.00 / $2,344.23
| Facility | | $204.17 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $125.89 / $295.12
| Professional | | $47.86 | $125.89 | $295.12 |