- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $1,000.00 / $6,606.93
| Facility | | $60.26 | $1,000.00 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | 50 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $60.26 / $151.36
| Professional | | $37.15 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $229.09 / $338.84
| Professional | 50 | $107.15 | $229.09 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $58.88 / $75.86
| Professional | | $52.48 | $58.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 50 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,122.02 / $1,778.28
| Facility | | $724.44 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $74.13
| Professional | | $38.02 | $53.70 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $93.33
| Professional | | $44.67 | $66.07 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $77.62 / $1,513.56
| Facility | | $43.65 | $77.62 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $616.60
| Professional | | $46.77 | $64.57 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | 50 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $575.44 / $1,548.82
| Facility | | $134.90 | $575.44 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $70.79
| Professional | | $33.88 | $47.86 | $70.79 |