- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $81.28
| Facility | | $42.66 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $173.78
| Professional | | $42.66 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $275.42
| Professional | 50 | $125.89 | $125.89 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $549.54 / $1,348.96
| Facility | | $199.53 | $549.54 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $3,162.28
| Facility | 50 | $691.83 | $1,096.48 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $154.88 / $288.40
| Professional | | $81.28 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $234.42 / $436.52
| Professional | 50 | $123.03 | $234.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $302.00 / $724.44
| Facility | | $208.93 | $302.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $181.97 / $338.84
| Professional | | $97.72 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $562.34
| Facility | | $234.42 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $173.78 / $302.00
| Professional | | $97.72 | $173.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $331.13
| Facility | | $60.26 | $114.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $165.96 / $346.74
| Professional | | $74.13 | $165.96 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,778.28 / $3,715.35
| Facility | | $776.25 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $245.47
| Professional | | $58.88 | $134.90 | $245.47 |