- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $204.17 / $562.34
| Facility | | $31.62 | $204.17 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $1,000.00
| Facility | 50 | $245.47 | $489.78 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $77.62 / $141.25
| Professional | | $25.12 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $123.03 / $269.15
| Professional | 50 | $42.66 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $75.86 / $134.90
| Professional | | $22.91 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 50 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,466.84 / $8,709.64
| Facility | | $1,513.56 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $45.71
| Professional | | $22.39 | $27.54 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $67.61
| Professional | 50 | $33.11 | $41.69 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $36.31
| Facility | | $25.12 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $112.20
| Professional | | $79.43 | $102.33 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $125.89
| Facility | | $29.51 | $45.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $125.89
| Professional | | $28.18 | $79.43 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $2,137.96 / $7,413.10
| Facility | | $138.04 | $2,137.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $63.10 / $131.83
| Professional | | $23.44 | $63.10 | $131.83 |