- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $1,445.44 / $6,760.83
| Facility | | $100.00 | $1,445.44 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $1,318.26 / $2,951.21
| Facility | 50 | $467.74 | $1,318.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $316.23
| Professional | | $57.54 | $102.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $190.55 / $524.81
| Professional | 50 | $87.10 | $190.55 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,801.89 / $10,000.00
| Facility | | $1,548.82 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $169.82
| Professional | | $54.95 | $89.13 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $245.47
| Professional | 50 | $81.28 | $131.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $302.00 / $870.96
| Facility | | $81.28 | $302.00 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $245.47
| Professional | | $66.07 | $114.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,174.90 / $3,548.13
| Facility | | $269.15 | $1,174.90 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $199.53
| Professional | | $56.23 | $97.72 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | 50 | $204.17 | $204.17 | $204.17 |