- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $676.08 / $6,025.60
| Facility | | $75.86 | $676.08 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 50 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $323.59
| Professional | | $48.98 | $109.65 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $190.55 / $457.09
| Professional | 50 | $75.86 | $190.55 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $120.23
| Professional | | $53.70 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $371.54
| Professional | 50 | $56.23 | $83.18 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | 53 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $208.93
| Professional | | $63.10 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $123.03 / $660.69
| Professional | | $43.65 | $123.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $109.65 / $123.03
| Professional | | $43.65 | $109.65 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,548.82 / $2,691.53
| Facility | | $676.08 | $1,548.82 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $194.98
| Professional | | $63.10 | $107.15 | $194.98 |