- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $58.88 / $257.04
| Facility | | $20.42 | $58.88 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $190.55
| Facility | 50 | $58.88 | $58.88 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $53.70 / $134.90
| Professional | | $28.84 | $53.70 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $309.03
| Professional | 50 | $64.57 | $100.00 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $151.36
| Professional | 52 | $29.51 | $33.11 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $204.17 / $1,071.52
| Facility | | $79.43 | $204.17 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $173.78
| Professional | | $56.23 | $93.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $416.87
| Facility | | $125.89 | $177.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $208.93
| Professional | | $69.18 | $128.82 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $169.82 / $331.13
| Facility | | $138.04 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $104.71 / $190.55
| Professional | | $69.18 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $1,445.44
| Facility | | $45.71 | $97.72 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $194.98 / $1,380.38 / $4,786.30
| Facility | 50 | $194.98 | $1,380.38 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $263.03
| Professional | | $58.88 | $102.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | 52 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,819.70 / $3,715.35
| Facility | | $154.88 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $169.82
| Professional | | $45.71 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | 50 | $112.20 | $112.20 | $112.20 |