- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $912.01 / $6,456.54
| Facility | | $72.44 | $912.01 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 50 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $218.78
| Professional | | $56.23 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $213.80 / $363.08
| Professional | 50 | $114.82 | $213.80 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $162.18
| Professional | | $63.10 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $151.36
| Professional | 50 | $70.79 | $97.72 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $204.17
| Facility | | $64.57 | $95.50 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $154.88
| Professional | | $64.57 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $91.20 / $524.81
| Professional | | $48.98 | $91.20 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $83.18 / $93.33
| Professional | | $48.98 | $83.18 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,479.11 / $2,691.53
| Facility | | $676.08 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $154.88
| Professional | | $64.57 | $95.50 | $154.88 |