- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $776.25 / $3,311.31
| Facility | | $50.12 | $776.25 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $1,445.44
| Facility | 50 | $100.00 | $190.55 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | 52 | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $107.15
| Professional | | $29.51 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $107.15 / $218.78
| Professional | 50 | $50.12 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $53.70
| Professional | 52 | $29.51 | $33.11 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $46.77 / $67.61
| Professional | | $28.84 | $46.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $100.00
| Professional | 50 | $38.02 | $58.88 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $112.20 / $177.83
| Facility | | $54.95 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $63.10
| Professional | | $32.36 | $43.65 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $45.71 / $45.71
| Facility | | $39.81 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $89.13
| Professional | | $33.11 | $54.95 | $89.13 |
- 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
- $30.90 / $46.77 / $83.18
| Professional | | $30.90 | $46.77 | $83.18 |