- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $954.99 / $4,897.79
| Facility | | $95.50 | $954.99 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $123.03 / $354.81
| Professional | | $61.66 | $123.03 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $549.54
| Professional | 50 | $537.03 | $537.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $69.18 / $97.72
| Professional | | $61.66 | $69.18 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $213.80
| Professional | | $64.57 | $109.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $512.86
| Professional | 50 | $165.96 | $316.23 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $147.91
| Facility | | $79.43 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $169.82 / $288.40
| Professional | | $120.23 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $199.53
| Professional | | $60.26 | $109.65 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $851.14 / $4,897.79
| Facility | | $95.50 | $851.14 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $141.25 / $269.15
| Professional | | $69.18 | $141.25 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $190.55
| Professional | | $57.54 | $100.00 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,621.81 / $3,801.89
| Facility | | $707.95 | $1,621.81 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $173.78
| Professional | | $66.07 | $107.15 | $173.78 |