- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $851.14 / $8,511.38
| Facility | | $41.69 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $75.86 / $194.98
| Professional | | $40.74 | $75.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $275.42 / $338.84 / $645.65
| Professional | 50 | $275.42 | $338.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $114.82
| Professional | | $66.07 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $169.82
| Professional | 50 | $100.00 | $120.23 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $67.61
| Facility | | $40.74 | $56.23 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $66.07
| Professional | | $41.69 | $54.95 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $102.33
| Facility | | $34.67 | $75.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $141.25 / $1,000.00
| Professional | | $61.66 | $141.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $53.70
| Professional | | $32.36 | $33.11 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $724.44 / $1,949.84
| Facility | | $58.88 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $97.72 / $154.88
| Professional | | $46.77 | $97.72 | $154.88 |