- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $660.69 / $2,630.27
| Facility | | $79.43 | $660.69 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.39 / $478.63 / $1,995.26
| Facility | 50 | $22.39 | $478.63 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $107.15 / $204.17
| Professional | | $56.23 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $190.55 / $309.03
| Professional | 50 | $85.11 | $190.55 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $102.33
| Facility | | $61.66 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $181.97 / $218.78
| Professional | | $91.20 | $181.97 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $100.00 / $100.00
| Facility | | $34.67 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $109.65 / $467.74
| Professional | | $57.54 | $109.65 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $851.14 / $1,348.96
| Facility | | $257.04 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $1,584.89 / $1,995.26
| Facility | 50 | $489.78 | $1,584.89 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $162.18
| Professional | | $91.20 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $239.88
| Professional | 50 | $123.03 | $199.53 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $851.14
| Facility | | $457.09 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $154.88
| Professional | | $52.48 | $91.20 | $154.88 |