- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $512.86 / $1,905.46
| Facility | | $109.65 | $512.86 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $245.47 / $758.58
| Professional | | $112.20 | $245.47 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $1,258.93
| Professional | 50 | $199.53 | $389.05 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $229.09 / $537.03
| Professional | | $131.83 | $229.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $812.83
| Professional | 50 | $199.53 | $338.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $776.25 / $1,258.93
| Facility | | $676.08 | $776.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $467.74 / $1,122.02
| Professional | | $190.55 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $251.19 / $3,162.28
| Facility | | $112.20 | $251.19 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $389.05 / $676.08
| Professional | | $223.87 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $575.44 / $1,000.00
| Professional | 50 | $331.13 | $575.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $263.03 / $3,630.78
| Facility | | $114.82 | $263.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $467.74 / $1,862.09
| Professional | | $213.80 | $467.74 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $257.04
| Professional | | $32.36 | $33.11 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,951.21 / $3,235.94
| Facility | | $190.55 | $2,951.21 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $758.58
| Professional | | $229.09 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $870.96
| Professional | | $218.78 | $426.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $776.25 / $1,445.44
| Facility | | $346.74 | $776.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,202.26 / $1,819.70
| Professional | | $229.09 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $891.25
| Professional | | $416.87 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $691.83 / $1,479.11
| Professional | | $125.89 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,754.23 / $5,011.87
| Facility | | $2,238.72 | $2,754.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $269.15 / $1,000.00
| Professional | | $93.33 | $269.15 | $1,000.00 |