- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $2,041.74 / $4,897.79
| Facility | | $204.17 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,412.54
| Facility | 50 | $1,380.38 | $1,380.38 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $389.05
| Professional | | $100.00 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $275.42 / $691.83 / $1,737.80
| Professional | 50 | $275.42 | $691.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Facility | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $257.04
| Professional | | $162.18 | $245.47 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $389.05
| Professional | 50 | $263.03 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $269.15
| Professional | | $102.33 | $165.96 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $2,041.74 / $4,897.79
| Facility | | $199.53 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,412.54
| Facility | 50 | $1,380.38 | $1,380.38 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $190.55 / $354.81
| Professional | | $114.82 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $645.65 / $1,174.90
| Professional | 50 | $151.36 | $645.65 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $269.15
| Professional | | $97.72 | $154.88 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,584.89 / $3,801.89
| Facility | | $562.34 | $1,584.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $245.47
| Professional | | $112.20 | $165.96 | $245.47 |