- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,290.87 / $5,623.41
| Facility | | $575.44 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $331.13 / $977.24
| Professional | | $109.65 | $331.13 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $575.44 / $977.24
| Professional | 50 | $239.88 | $575.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $245.47 / $457.09
| Professional | | $93.33 | $245.47 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | 50 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $346.74 / $645.65
| Facility | | $79.43 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $512.86 / $1,000.00
| Professional | | $104.71 | $512.86 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $398.11 / $954.99
| Professional | | $114.82 | $398.11 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $524.81 / $1,122.02
| Facility | | $114.82 | $524.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $812.83 / $4,570.88
| Professional | | $467.74 | $812.83 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | 50 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,023.29 / $2,137.96
| Facility | | $512.86 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $407.38 / $831.76
| Professional | | $112.20 | $407.38 | $831.76 |