- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,548.82 / $5,623.41
| Facility | | $346.74 | $1,548.82 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $1,318.26 / $3,388.44
| Facility | 50 | $389.05 | $1,318.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $100.00 / $346.74
| Professional | | $43.65 | $100.00 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $316.23 / $741.31
| Professional | 50 | $66.07 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $64.57 / $74.13
| Professional | | $36.31 | $64.57 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | 50 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $831.76 / $1,548.82
| Facility | | $204.17 | $831.76 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $52.48 / $104.71
| Professional | | $28.84 | $52.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $83.18 / $144.54
| Professional | | $45.71 | $83.18 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $87.10 / $1,698.24
| Facility | | $39.81 | $87.10 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,630.27
| Facility | 50 | $2,187.76 | $2,187.76 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $1,348.96
| Professional | | $70.79 | $114.82 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,258.93 / $3,235.94
| Facility | | $602.56 | $1,258.93 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $75.86 / $125.89
| Professional | | $41.69 | $75.86 | $125.89 |