- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $1,174.90 / $2,691.53
| Facility | | $44.67 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $165.96 / $1,778.28
| Facility | 50 | $83.18 | $165.96 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 52 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $141.25
| Professional | | $32.36 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $302.00
| Professional | 50 | $70.79 | $114.82 | $302.00 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $70.79
| Professional | | $34.67 | $44.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $100.00
| Professional | 50 | $54.95 | $79.43 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,445.44 / $1,995.26
| Facility | | $524.81 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $102.33
| Professional | | $37.15 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $91.20
| Professional | | $34.67 | $52.48 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $2,951.21 / $2,951.21
| Facility | | $54.95 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 52 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $398.11 / $398.11
| Professional | | $346.74 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $812.83 / $2,344.23
| Facility | | $229.09 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $93.33
| Professional | | $33.11 | $53.70 | $93.33 |