- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $371.54 / $4,897.79
| Facility | | $58.88 | $371.54 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $281.84
| Professional | | $61.66 | $131.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | 50 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $125.89
| Professional | 52 | $54.95 | $54.95 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $138.04
| Professional | | $85.11 | $120.23 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $3,981.07
| Facility | | $676.08 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $169.82
| Professional | | $63.10 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $257.04
| Professional | 50 | $93.33 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $141.25
| Professional | | $63.10 | $109.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $117.49 / $199.53
| Professional | | $69.18 | $117.49 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $120.23 / $891.25
| Facility | | $54.95 | $120.23 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $851.14
| Professional | | $97.72 | $144.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $549.54 / $1,513.56
| Facility | | $158.49 | $549.54 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $158.49
| Professional | | $60.26 | $100.00 | $158.49 |