- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $229.09 / $457.09
| Facility | | $64.57 | $229.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $309.03 / $1,548.82
| Facility | 50 | $109.65 | $309.03 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $123.03
| Professional | | $32.36 | $57.54 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $112.20 / $190.55
| Professional | 50 | $53.70 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | 52 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $114.82
| Professional | | $38.90 | $53.70 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $100.00 / $323.59
| Facility | | $36.31 | $100.00 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $309.03 / $2,818.38
| Facility | 50 | $109.65 | $309.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $109.65 / $302.00
| Professional | | $45.71 | $109.65 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $112.20 / $190.55
| Professional | 50 | $53.70 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | 52 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $263.03
| Professional | | $131.83 | $194.98 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $234.42
| Facility | | $36.31 | $61.66 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $72.44 / $107.15
| Professional | | $44.67 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $91.20 / $186.21
| Professional | | $41.69 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |