- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $363.08 / $1,096.48
| Facility | | $79.43 | $363.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 50 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $302.00
| Professional | | $48.98 | $109.65 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $275.42 / $933.25
| Professional | 50 | $54.95 | $275.42 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $91.20
| Professional | | $46.77 | $75.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $131.83 / $338.84
| Professional | | $79.43 | $131.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $398.11
| Facility | | $141.25 | $141.25 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $131.83 / $234.42
| Professional | | $67.61 | $131.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $269.15
| Professional | | $181.97 | $181.97 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $114.82 / $199.53
| Facility | | $52.48 | $114.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $173.78 / $257.04
| Professional | | $72.44 | $173.78 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $724.44 / $1,949.84
| Facility | | $234.42 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $100.00 / $199.53
| Professional | | $48.98 | $100.00 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |