- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $1,230.27 / $5,370.32
| Facility | | $85.11 | $1,230.27 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.93 / $2,089.30 / $4,677.35
| Facility | 50 | $0.93 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $208.93 / $741.31
| Professional | | $57.54 | $208.93 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $194.98 / $1,000.00
| Professional | 50 | $81.28 | $194.98 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $269.15 / $707.95
| Professional | | $104.71 | $269.15 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $275.42 / $691.83
| Professional | | $58.88 | $275.42 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $295.12 / $1,380.38
| Facility | | $85.11 | $295.12 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 50 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $331.13 / $891.25
| Professional | | $147.91 | $331.13 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $380.19 / $616.60
| Professional | | $128.82 | $380.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $323.59 / $616.60
| Professional | | $112.20 | $323.59 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,621.81 / $2,951.21
| Facility | | $1,148.15 | $1,621.81 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $165.96 / $446.68
| Professional | | $61.66 | $165.96 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $354.81 / $524.81
| Professional | | $112.20 | $354.81 | $524.81 |