- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $4,365.16 / $10,000.00
| Facility | | $100.00 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $1,202.26 / $6,309.57
| Facility | 50 | $112.20 | $1,202.26 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $131.83
| Professional | | $29.51 | $53.70 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $251.19
| Professional | 50 | $70.79 | $100.00 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $151.36
| Professional | 52 | $29.51 | $33.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $45.71 / $48.98
| Professional | | $43.65 | $45.71 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $14,454.40 / $22,387.21
| Facility | | $8,709.64 | $14,454.40 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $107.15
| Professional | | $42.66 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $169.82
| Professional | | $33.11 | $61.66 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $91.20
| Professional | | $48.98 | $56.23 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $302.00
| Facility | | $120.23 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $100.00
| Professional | | $26.30 | $50.12 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,630.27 / $6,606.93
| Facility | | $1,318.26 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $39.81 / $85.11
| Professional | | $18.20 | $39.81 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Professional | 50 | $177.83 | $177.83 | $177.83 |