- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $58.88 / $2,818.38
| Facility | | $20.42 | $58.88 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $60.26 / $120.23
| Professional | | $28.84 | $60.26 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $269.15
| Professional | 50 | $70.79 | $100.00 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $151.36
| Professional | 52 | $34.67 | $34.67 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $112.20
| Professional | | $61.66 | $83.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $134.90
| Professional | 22 | $74.13 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $147.91
| Professional | | $46.77 | $83.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $141.25
| Facility | | $33.11 | $56.23 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Facility | 50 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $87.10 / $102.33
| Professional | | $47.86 | $87.10 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $102.33
| Professional | | $34.67 | $63.10 | $102.33 |