- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $5,623.41
| Facility | | $131.83 | $181.97 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $371.54
| Professional | | $109.65 | $154.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $380.19 / $602.56
| Professional | 50 | $169.82 | $380.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $120.23 / $194.98
| Professional | | $60.26 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $186.21 / $295.12
| Professional | 50 | $181.97 | $186.21 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $4,265.80 / $8,317.64
| Facility | | $2,089.30 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $199.53
| Professional | | $100.00 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $295.12
| Professional | 50 | $147.91 | $177.83 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $154.88
| Facility | | $107.15 | $134.90 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $177.83
| Professional | | $123.03 | $158.49 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $125.89
| Facility | | $107.15 | $107.15 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $316.23
| Professional | | $120.23 | $177.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,137.96 / $7,413.10
| Facility | | $257.04 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $251.19
| Professional | | $102.33 | $151.36 | $251.19 |