- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $426.58 / $6,165.95
| Facility | | $29.51 | $426.58 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $22.91 / $54.95
| Professional | | $12.88 | $22.91 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.95 / $38.90 / $91.20
| Professional | 50 | $19.95 | $38.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $69.18
| Professional | 52 | $12.30 | $17.78 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $4.57 / $10.96 / $64.57
| Professional | 53 | $4.57 | $10.96 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $602.56 / $4,897.79
| Facility | | $21.88 | $602.56 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $19.95 / $37.15
| Professional | | $11.75 | $19.95 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $51.29
| Professional | 50 | $17.38 | $26.92 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $50.12 / $144.54
| Facility | | $20.89 | $50.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $21.38 / $50.12
| Professional | | $14.13 | $21.38 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $8.91 / $9.55 / $36.31
| Professional | 53 | $8.91 | $9.55 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $977.24 / $3,311.31
| Facility | | $109.65 | $977.24 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $35.48
| Professional | | $11.48 | $17.78 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $44.67 / $79.43 / $85.11
| Professional | 50 | $44.67 | $79.43 | $85.11 |