- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $54.95 / $2,137.96
| Facility | | $25.12 | $54.95 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.50 / $54.95
| Professional | | $13.80 | $19.50 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $21.38 / $43.65 / $89.13
| Professional | 50 | $21.38 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.95 / $69.18 / $69.18
| Professional | 52 | $19.95 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | 53 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $302.00 / $489.78
| Facility | | $83.18 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $18.20 / $23.44
| Professional | | $11.22 | $18.20 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $18.20 / $27.54
| Professional | | $10.47 | $18.20 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $33.11
| Professional | | $23.44 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $21.38 / $37.15
| Facility | | $12.02 | $21.38 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.05 / $27.54
| Professional | | $13.49 | $19.05 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $1,096.48 / $1,412.54
| Facility | | $114.82 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $19.95 / $28.18
| Professional | | $15.49 | $19.95 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |