- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $2,041.74 / $7,079.46
| Facility | | $120.23 | $2,041.74 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $20.89 / $41.69
| Professional | | $12.59 | $20.89 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.20 / $35.48 / $70.79
| Professional | 50 | $18.20 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.59 / $16.60 / $17.78
| Professional | 52 | $12.59 | $16.60 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $33.11
| Professional | | $13.49 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $43.65
| Professional | 50 | $20.42 | $27.54 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,398.83 / $4,168.69
| Facility | | $794.33 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $20.42 / $27.54
| Professional | | $12.88 | $20.42 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $41.69
| Professional | 50 | $19.05 | $30.90 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $19.50 / $25.12
| Facility | | $17.78 | $19.50 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $19.50 / $31.62
| Professional | | $18.20 | $19.50 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $34.67
| Professional | | $14.13 | $21.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $20.89 / $93.33
| Professional | | $17.38 | $20.89 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $11.48
| Professional | 52 | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $11.48
| Professional | 53 | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,584.89
| Facility | | $1,288.25 | $1,288.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $36.31
| Professional | | $25.70 | $32.36 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,318.26 / $2,344.23
| Facility | | $177.83 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.62 / $33.88
| Professional | | $12.88 | $18.62 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |