- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $194.98 / $851.14
| Facility | | $38.90 | $194.98 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $141.25 / $331.13
| Professional | | $38.90 | $141.25 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $239.88 / $575.44
| Facility | | $1.00 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $213.80 / $616.60
| Professional | | $72.44 | $213.80 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $316.23 / $912.01
| Professional | 50 | $109.65 | $316.23 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $691.83 / $1,659.59
| Facility | | $426.58 | $691.83 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $169.82 / $645.65
| Professional | | $60.26 | $169.82 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $1,230.27
| Facility | | $501.19 | $630.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $269.15 / $602.56
| Professional | | $85.11 | $269.15 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $165.96 / $446.68
| Facility | | $43.65 | $165.96 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $316.23 / $1,348.96
| Professional | | $162.18 | $316.23 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,862.09 / $5,370.32
| Facility | | $380.19 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $275.42 / $389.05
| Professional | | $54.95 | $275.42 | $389.05 |