- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $114.82 / $489.78
| Facility | | $37.15 | $114.82 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $616.60
| Facility | 50 | $371.54 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $61.66 / $138.04
| Professional | | $18.20 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $1,023.29
| Professional | 50 | $100.00 | $100.00 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,412.54 / $3,467.37
| Facility | | $1,288.25 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $50.12 / $70.79
| Professional | | $22.91 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $34.67 / $74.13 / $104.71
| Professional | 50 | $34.67 | $74.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $95.50 / $234.42
| Professional | | $33.11 | $95.50 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $91.20 / $190.55
| Professional | | $28.18 | $91.20 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $89.13 / $208.93
| Professional | | $30.20 | $89.13 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $16.22 / $112.20
| Facility | | $15.85 | $16.22 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 50 | $114.82 | $114.82 | $114.82 |