- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $457.09 / $4,265.80
| Facility | | $40.74 | $457.09 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $58.88 / $891.25 / $2,570.40
| Facility | 50 | $58.88 | $891.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $100.00
| Professional | | $29.51 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $147.91
| Professional | 50 | $52.48 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $151.36
| Professional | 52 | $34.67 | $42.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $37.15 / $40.74
| Professional | | $36.31 | $37.15 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | 50 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,570.88 / $8,912.51
| Facility | | $2,238.72 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $79.43
| Professional | | $28.84 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $117.49
| Professional | 50 | $43.65 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $69.18
| Professional | | $28.18 | $48.98 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $158.49
| Professional | | $36.31 | $61.66 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $891.25
| Facility | | $35.48 | $63.10 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | 50 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | 52 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $354.81
| Professional | | $47.86 | $75.86 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $537.03 / $1,513.56
| Facility | | $46.77 | $537.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $83.18
| Professional | | $33.88 | $50.12 | $83.18 |