- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $660.69 / $1,122.02
| Facility | | $44.67 | $660.69 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $83.18 / $288.40
| Professional | | $43.65 | $83.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $954.99
| Professional | 50 | $100.00 | $154.88 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $549.54 / $1,348.96
| Facility | | $109.65 | $549.54 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $3,162.28
| Facility | 50 | $691.83 | $1,096.48 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $302.00
| Professional | | $83.18 | $158.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $446.68
| Professional | 50 | $125.89 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $309.03 / $741.31
| Facility | | $213.80 | $309.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $354.81
| Professional | | $100.00 | $186.21 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $575.44
| Facility | | $239.88 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $173.78 / $309.03
| Professional | | $100.00 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $123.03 / $758.58
| Facility | | $54.95 | $123.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $181.97 / $426.58
| Professional | | $83.18 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $691.83
| Professional | 50 | $251.19 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,778.28 / $3,715.35
| Facility | | $776.25 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $112.20 / $251.19
| Professional | | $58.88 | $112.20 | $251.19 |