- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $1,096.48 / $3,467.37
| Facility | | $43.65 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.50 / $45.71
| Professional | | $13.80 | $19.50 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $72.44
| Professional | 50 | $21.88 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | 52 | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $25.12
| Professional | | $12.88 | $16.60 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.98 / $20.42 / $37.15
| Professional | 50 | $16.98 | $20.42 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $269.15
| Facility | | $67.61 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.60 / $19.95
| Professional | | $13.80 | $16.60 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $39.81
| Facility | | $18.20 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $17.78 / $26.30
| Professional | | $10.96 | $17.78 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $416.87 / $1,258.93
| Facility | | $89.13 | $416.87 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $24.55
| Professional | | $10.96 | $15.14 | $24.55 |