- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,290.87 / $6,760.83
| Facility | | $758.58 | $2,290.87 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $2,344.23 / $4,570.88
| Facility | 50 | $794.33 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $416.87
| Professional | | $100.00 | $190.55 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $338.84 / $1,380.38
| Professional | 50 | $204.17 | $338.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $181.97 / $302.00
| Professional | | $93.33 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $512.86
| Professional | 50 | $151.36 | $281.84 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,412.54 / $7,413.10
| Facility | | $213.80 | $1,412.54 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $213.80
| Professional | | $100.00 | $169.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $478.63 / $501.19
| Facility | | $177.83 | $478.63 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $346.74
| Professional | | $104.71 | $186.21 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,388.44 / $8,912.51
| Facility | | $2,290.87 | $3,388.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $213.80
| Professional | | $102.33 | $158.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $81.28 / $263.03
| Professional | | $32.36 | $81.28 | $263.03 |
- 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
- $87.10 / $162.18 / $331.13
| Professional | | $87.10 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $147.91 / $208.93
| Professional | | $81.28 | $147.91 | $208.93 |