- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $1,000.00 / $4,466.84
| Facility | | $64.57 | $1,000.00 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $1,148.15 / $1,230.27
| Facility | 50 | $933.25 | $1,148.15 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $186.21
| Professional | | $38.90 | $72.44 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $346.74
| Professional | 50 | $177.83 | $269.15 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $63.10
| Professional | | $33.88 | $48.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $112.20
| Professional | 50 | $50.12 | $50.12 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,659.59 / $2,630.27
| Facility | | $1,071.52 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $100.00
| Professional | | $40.74 | $74.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $147.91
| Professional | | $51.29 | $97.72 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $114.82 / $2,398.83
| Facility | | $41.69 | $114.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $691.83
| Facility | 50 | $660.69 | $660.69 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $100.00 / $1,348.96
| Professional | | $63.10 | $100.00 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,174.90 / $2,290.87
| Facility | | $269.15 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $107.15
| Professional | | $38.02 | $67.61 | $107.15 |