- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $741.31 / $4,570.88
| Facility | | $74.13 | $741.31 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $630.96 / $1,380.38
| Facility | 50 | $512.86 | $630.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $72.44 / $162.18
| Professional | | $43.65 | $72.44 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $97.72 / $295.12
| Professional | 50 | $69.18 | $97.72 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $79.43
| Professional | | $39.81 | $60.26 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $144.54
| Professional | 50 | $83.18 | $97.72 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $524.81 / $1,000.00
| Facility | | $223.87 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $93.33
| Professional | | $40.74 | $64.57 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $575.44
| Facility | | $54.95 | $54.95 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $128.82
| Professional | | $52.48 | $77.62 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $131.83
| Facility | | $51.29 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,122.02 / $4,677.35
| Facility | | $234.42 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $102.33
| Professional | | $40.74 | $60.26 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |