- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $165.96 / $331.13
| Facility | | $75.86 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $275.42
| Professional | | $48.98 | $104.71 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Professional | 50 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $218.78
| Professional | | $64.57 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $234.42
| Professional | | $46.77 | $91.20 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $1,148.15
| Facility | | $72.44 | $134.90 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $398.11
| Professional | | $72.44 | $131.83 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $131.83 / $194.98
| Professional | | $114.82 | $131.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $194.98
| Professional | | $95.50 | $134.90 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $3,235.94 / $4,677.35
| Facility | | $416.87 | $3,235.94 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $169.82
| Professional | | $52.48 | $95.50 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $562.34 / $2,344.23
| Facility | | $245.47 | $562.34 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $177.83
| Professional | | $51.29 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $169.82
| Professional | | $97.72 | $114.82 | $169.82 |