- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $6,606.93
| Facility | | $208.93 | $309.03 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $302.00
| Professional | | $109.65 | $144.54 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $602.56
| Professional | 50 | $151.36 | $194.98 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $354.81
| Professional | | $138.04 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $323.59
| Professional | | $199.53 | $251.19 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $190.55 / $302.00
| Facility | | $114.82 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $338.84
| Professional | | $154.88 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $602.56
| Professional | 50 | $151.36 | $194.98 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $263.03
| Facility | | $173.78 | $245.47 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $302.00
| Facility | | $117.49 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $223.87 / $331.13
| Professional | | $79.43 | $223.87 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,230.27
| Facility | | $724.44 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $1,862.09
| Facility | 50 | $1,071.52 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $363.08
| Professional | | $194.98 | $281.84 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,380.38 / $5,128.61
| Facility | | $676.08 | $1,380.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $331.13
| Professional | | $144.54 | $223.87 | $331.13 |