- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $630.96 / $8,511.38
| Facility | | $112.20 | $630.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $346.74
| Professional | | $112.20 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $645.65
| Professional | 50 | $295.12 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | 50 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $208.93
| Professional | | $87.10 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $316.23
| Professional | 50 | $131.83 | $204.17 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $177.83
| Facility | | $109.65 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $181.97
| Professional | | $100.00 | $147.91 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $1,659.59
| Facility | | $134.90 | $204.17 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $891.25
| Professional | | $123.03 | $213.80 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $724.44 / $1,949.84
| Facility | | $58.88 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $169.82 / $288.40
| Professional | | $104.71 | $169.82 | $288.40 |