- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $7,943.28
| Facility | | $169.82 | $239.88 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $288.40
| Professional | | $83.18 | $128.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $323.59
| Professional | | $123.03 | $208.93 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $302.00
| Professional | | $147.91 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $281.84
| Facility | | $112.20 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $208.93 / $309.03
| Professional | | $125.89 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $229.09 / $239.88
| Facility | | $141.25 | $229.09 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $281.84
| Facility | | $112.20 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $208.93 / $309.03
| Professional | | $79.43 | $208.93 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,398.83 / $2,818.38
| Facility | | $1,737.80 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $331.13
| Professional | | $162.18 | $234.42 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,630.27 / $4,897.79
| Facility | | $1,548.82 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $309.03
| Professional | | $123.03 | $204.17 | $309.03 |