- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $602.56 / $5,370.32
| Facility | | $75.86 | $602.56 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $1,819.70 / $4,897.79
| Facility | 50 | $724.44 | $1,819.70 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $138.04 / $363.08
| Professional | | $85.11 | $138.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $229.09 / $724.44
| Professional | 50 | $151.36 | $229.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $234.42 / $331.13
| Professional | | $123.03 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $588.84
| Professional | | $81.28 | $141.25 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $302.00 / $1,380.38
| Facility | | $134.90 | $302.00 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $1,174.90
| Professional | | $123.03 | $251.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $218.78
| Professional | 50 | $32.36 | $32.36 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $239.88 / $371.54
| Professional | | $229.09 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,174.90 / $3,311.31
| Facility | | $354.81 | $1,174.90 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $239.88
| Professional | | $77.62 | $141.25 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,023.29 / $2,344.23
| Facility | | $489.78 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $302.00
| Professional | | $100.00 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $251.19
| Professional | | $165.96 | $204.17 | $251.19 |