- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $2,511.89 / $7,413.10
| Facility | | $100.00 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $190.55
| Professional | | $69.18 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | 50 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $120.23
| Professional | | $69.18 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $181.97
| Professional | 50 | $104.71 | $131.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $125.89
| Professional | | $63.10 | $85.11 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $389.05
| Facility | | $52.48 | $52.48 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $295.12
| Professional | | $67.61 | $104.71 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $134.90 / $2,630.27
| Facility | | $54.95 | $134.90 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $616.60
| Professional | | $77.62 | $112.20 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,148.15 / $2,691.53
| Facility | | $794.33 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $138.04
| Professional | | $64.57 | $83.18 | $138.04 |