- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $4,365.16
| Facility | | $54.95 | $81.28 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | 50 | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $100.00 / $190.55
| Professional | | $54.95 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $660.69
| Professional | 50 | $117.49 | $186.21 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $112.20
| Facility | | $109.65 | $109.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $239.88
| Professional | | $114.82 | $162.18 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $173.78
| Facility | | $74.13 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $162.18 / $616.60
| Professional | | $69.18 | $162.18 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $173.78
| Professional | | $131.83 | $131.83 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $125.89 / $169.82
| Professional | | $117.49 | $125.89 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $162.18
| Professional | | $83.18 | $120.23 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $208.93
| Professional | | $64.57 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $194.98
| Professional | | $109.65 | $134.90 | $194.98 |