- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $239.88 / $4,265.80
| Facility | | $114.82 | $239.88 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $467.74 / $1,000.00
| Facility | 50 | $436.52 | $467.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $229.09 / $537.03
| Professional | | $75.86 | $229.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $398.11 / $741.31
| Professional | 50 | $87.10 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $138.04
| Professional | | $69.18 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $245.47 / $537.03
| Professional | | $104.71 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $204.17 / $478.63
| Professional | | $97.72 | $204.17 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $208.93 / $371.54
| Facility | | $77.62 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $588.84
| Professional | | $131.83 | $131.83 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $776.25 / $1,949.84
| Facility | | $173.78 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $398.11
| Professional | | $79.43 | $186.21 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $19,498.45
| Facility | | $1,995.26 | $1,995.26 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $2,041.74
| Professional | | $1,737.80 | $1,737.80 | $2,041.74 |