- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $2,041.74 / $5,623.41
| Facility | | $239.88 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $69.18
| Professional | | $12.88 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $20.89 / $43.65 / $102.33
| Professional | 50 | $20.89 | $43.65 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $38.90 / $114.82
| Professional | 52 | $16.22 | $38.90 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $67.61
| Professional | 53 | $16.98 | $19.50 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.88 / $15.14
| Professional | | $12.59 | $12.88 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.22 / $16.98 / $25.70
| Professional | 50 | $16.22 | $16.98 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $52.48 / $97.72
| Facility | | $12.02 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.49 / $66.07
| Professional | | $13.80 | $15.49 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $30.20
| Professional | | $13.18 | $17.38 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $28.84 / $1,995.26
| Facility | | $15.14 | $28.84 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $15.85 / $39.81
| Professional | | $11.75 | $15.85 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $933.25 / $2,137.96
| Facility | | $50.12 | $933.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $28.18
| Professional | | $11.48 | $14.79 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | 50 | $33.11 | $33.11 | $33.11 |