- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $165.96 / $416.87
| Facility | | $45.71 | $165.96 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $138.04 / $371.54 / $575.44
| Facility | 50 | $138.04 | $371.54 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | 52 | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $100.00
| Professional | | $29.51 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $100.00 / $177.83
| Professional | 50 | $69.18 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $151.36
| Professional | 52 | $29.51 | $34.67 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $54.95
| Facility | | $33.11 | $41.69 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $104.71 / $107.15
| Professional | | $36.31 | $104.71 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $54.95
| Facility | | $34.67 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | 52 | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $281.84
| Professional | | $36.31 | $52.48 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $173.78 / $288.40
| Facility | | $72.44 | $173.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $281.84 / $323.59
| Facility | 50 | $165.96 | $281.84 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $457.09
| Facility | | $165.96 | $165.96 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $75.86
| Professional | | $28.18 | $44.67 | $75.86 |