- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $1,288.25 / $6,025.60
| Facility | | $125.89 | $1,288.25 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3.55 / $275.42 / $3,019.95
| Facility | 50 | $3.55 | $275.42 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $478.63
| Professional | | $100.00 | $147.91 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $1,071.52
| Professional | 50 | $165.96 | $416.87 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $288.40 / $389.05
| Professional | | $134.90 | $288.40 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $177.83 / $380.19
| Professional | | $104.71 | $177.83 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $288.40 / $1,148.15
| Facility | | $144.54 | $288.40 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $812.83
| Facility | 50 | $741.31 | $741.31 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $257.04 / $776.25
| Professional | | $131.83 | $257.04 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $288.40 / $371.54
| Professional | | $239.88 | $288.40 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $436.52
| Professional | | $239.88 | $239.88 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $954.99 / $2,344.23
| Facility | | $457.09 | $954.99 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $323.59
| Professional | | $107.15 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $316.23
| Professional | | $213.80 | $251.19 | $316.23 |