- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $288.40 / $575.44
| Facility | | $50.12 | $288.40 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $1,023.29
| Facility | 50 | $331.13 | $331.13 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $47.86 / $100.00
| Professional | | $23.99 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $169.82
| Professional | 50 | $31.62 | $31.62 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $758.58 / $1,202.26
| Facility | | $489.78 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $60.26 / $81.28
| Professional | | $25.70 | $60.26 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $83.18
| Professional | | $34.67 | $58.88 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $74.13 / $1,513.56
| Facility | | $30.20 | $74.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $478.63
| Professional | | $48.98 | $64.57 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $537.03 / $1,548.82
| Facility | | $100.00 | $537.03 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $43.65 / $70.79
| Professional | | $23.99 | $43.65 | $70.79 |