- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $251.19 / $912.01
| Facility | | $70.79 | $251.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $338.84
| Professional | | $57.54 | $95.50 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $549.54
| Professional | 50 | $120.23 | $151.36 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $218.78
| Professional | | $74.13 | $74.13 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $4,466.84 / $12,022.64
| Facility | | $2,511.89 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $208.93
| Professional | | $70.79 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $288.40
| Professional | 50 | $77.62 | $107.15 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,000.00 / $2,041.74
| Facility | | $85.11 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $223.87
| Professional | | $72.44 | $114.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $177.83
| Professional | | $61.66 | $95.50 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $125.89
| Professional | | $60.26 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $85.11 / $158.49
| Professional | | $53.70 | $85.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $1,288.25
| Facility | | $54.95 | $56.23 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $660.69
| Professional | | $562.34 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $107.15
| Professional | | $64.57 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $147.91
| Facility | | $63.10 | $95.50 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $173.78
| Professional | | $61.66 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $251.19
| Professional | | $181.97 | $181.97 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $158.49
| Professional | | $56.23 | $104.71 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,548.82 / $6,456.54
| Facility | | $537.03 | $1,548.82 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $162.18
| Professional | | $48.98 | $77.62 | $162.18 |