- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $2,884.03 / $8,128.31
| Facility | | $117.49 | $2,884.03 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $537.03 / $954.99 / $2,454.71
| Facility | 50 | $537.03 | $954.99 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $239.88
| Professional | | $52.48 | $100.00 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $245.47 / $1,071.52
| Professional | 50 | $125.89 | $245.47 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $162.18
| Professional | 50 | $100.00 | $100.00 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,905.46 / $11,220.18
| Facility | | $239.88 | $1,905.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $151.36
| Professional | | $52.48 | $89.13 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $478.63 / $501.19
| Facility | | $93.33 | $478.63 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $112.20 / $218.78
| Professional | | $57.54 | $112.20 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,388.44 / $7,585.78
| Facility | | $2,290.87 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $151.36
| Professional | | $66.07 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $134.90
| Professional | | $32.36 | $41.69 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,290.87 / $5,011.87
| Facility | | $588.84 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $190.55
| Professional | | $53.70 | $93.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $74.13 / $100.00
| Professional | | $41.69 | $74.13 | $100.00 |