- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $977.24 / $4,677.35
| Facility | | $100.00 | $977.24 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $954.99 / $5,623.41
| Facility | 50 | $81.28 | $954.99 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $112.20 / $316.23
| Professional | | $58.88 | $112.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $741.31
| Professional | 50 | $131.83 | $239.88 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $97.72 / $134.90
| Professional | | $75.86 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $223.87
| Professional | 50 | $117.49 | $147.91 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $1,318.26
| Facility | | $389.05 | $467.74 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $194.98
| Professional | | $67.61 | $112.20 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $181.97
| Professional | | $66.07 | $104.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $478.63
| Professional | | $87.10 | $162.18 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $75.86 / $134.90
| Professional | | $69.18 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $151.36
| Professional | | $32.36 | $32.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $724.44 / $2,089.30
| Facility | | $223.87 | $724.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $199.53
| Professional | | $64.57 | $100.00 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $234.42
| Professional | 50 | $75.86 | $75.86 | $234.42 |