- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $234.42
| Facility | | $43.65 | $64.57 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 50 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $100.00
| Professional | | $25.70 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $234.42
| Professional | 50 | $69.18 | $69.18 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $204.17
| Facility | | $147.91 | $147.91 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $89.13
| Professional | | $28.18 | $37.15 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.88 / $100.00
| Facility | | $33.11 | $33.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- 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
- $31.62 / $60.26 / $100.00
| Professional | | $31.62 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $89.13 / $102.33
| Professional | | $43.65 | $89.13 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $309.03 / $707.95
| Facility | | $128.82 | $309.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $54.95 / $91.20
| Professional | | $27.54 | $54.95 | $91.20 |