- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $660.69
| Facility | | $114.82 | $134.90 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 50 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $158.49 / $295.12
| Professional | | $114.82 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $1,000.00
| Professional | 50 | $218.78 | $380.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $1,348.96
| Facility | | $275.42 | $575.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $1,096.48 / $3,162.28
| Facility | 50 | $691.83 | $1,096.48 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $501.19
| Professional | | $208.93 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $309.03 / $478.63 / $741.31
| Professional | 50 | $309.03 | $478.63 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $1,202.26
| Facility | | $354.81 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $588.84
| Professional | | $234.42 | $380.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $478.63 / $954.99
| Facility | | $389.05 | $478.63 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $549.54
| Professional | | $229.09 | $338.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $562.34
| Facility | | $134.90 | $239.88 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $575.44 / $10,964.78
| Facility | 50 | $72.44 | $575.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $263.03 / $1,412.54
| Professional | | $138.04 | $263.03 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,778.28 / $3,715.35
| Facility | | $776.25 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $245.47 / $457.09
| Professional | | $131.83 | $245.47 | $457.09 |