- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $204.17
| Facility | | $107.15 | $141.25 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $194.98
| Professional | | $58.88 | $97.72 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $154.88
| Professional | 50 | $120.23 | $147.91 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $199.53
| Professional | | $79.43 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $199.53
| Professional | | $97.72 | $144.54 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $109.65 / $169.82
| Facility | | $72.44 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $190.55
| Professional | | $87.10 | $128.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $154.88
| Professional | 50 | $120.23 | $147.91 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $154.88
| Facility | | $93.33 | $147.91 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $109.65 / $173.78
| Facility | | $72.44 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $194.98
| Professional | | $79.43 | $128.82 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $912.01 / $1,023.29
| Facility | | $645.65 | $912.01 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $208.93
| Professional | | $102.33 | $144.54 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,202.26 / $5,128.61
| Facility | | $676.08 | $1,202.26 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $190.55
| Professional | | $81.28 | $125.89 | $190.55 |