- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $1,348.96 / $7,413.10
| Facility | | $44.67 | $1,348.96 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $489.78 / $3,235.94
| Facility | 50 | $81.28 | $489.78 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $81.28
| Professional | | $29.51 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.90 / $69.18 / $102.33
| Professional | 50 | $30.90 | $69.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | 52 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $72.44
| Professional | | $29.51 | $41.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $54.95 / $72.44
| Professional | 50 | $52.48 | $54.95 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $512.86 / $549.54
| Facility | | $100.00 | $512.86 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $67.61
| Professional | | $45.71 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $93.33
| Professional | | $33.88 | $53.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $1,096.48
| Facility | | $38.90 | $60.26 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $354.81
| Professional | | $47.86 | $64.57 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $380.19 / $1,905.46
| Facility | | $43.65 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $51.29 / $74.13
| Professional | | $34.67 | $51.29 | $74.13 |