- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $446.68
| Facility | | $162.18 | $213.80 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $257.04
| Professional | | $100.00 | $151.36 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $380.19 / $691.83
| Facility | | $114.82 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $524.81 / $1,047.13
| Facility | 50 | $169.82 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $257.04
| Professional | | $162.18 | $199.53 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $218.78
| Professional | | $112.20 | $158.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $302.00
| Facility | | $107.15 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $263.03
| Professional | | $144.54 | $213.80 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $851.14
| Facility | | $478.63 | $602.56 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $1,258.93
| Facility | 50 | $724.44 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $208.93 / $269.15
| Professional | | $165.96 | $208.93 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $416.87
| Professional | | $117.49 | $154.88 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $251.19
| Professional | | $112.20 | $165.96 | $251.19 |