- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $213.80 / $4,466.84
| Facility | | $26.30 | $213.80 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $50.12
| Professional | | $12.59 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $91.20
| Professional | 50 | $19.50 | $36.31 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.00 / $19.95 / $67.61
| Professional | 52 | $10.00 | $19.95 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $4.57 / $6.46 / $20.89
| Professional | 53 | $4.57 | $6.46 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $14.79 / $21.88
| Professional | | $12.59 | $14.79 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $33.11
| Professional | 50 | $17.78 | $26.92 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | 53 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $309.03
| Facility | | $75.86 | $91.20 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $26.30
| Professional | | $17.78 | $23.99 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $29.51
| Professional | | $14.45 | $20.89 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $87.10
| Professional | | $16.98 | $26.30 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.62 / $20.42
| Professional | | $18.20 | $18.62 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $645.65 / $2,089.30
| Facility | | $50.12 | $645.65 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $28.84
| Professional | | $12.88 | $18.20 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $79.43 / $85.11
| Professional | 50 | $70.79 | $79.43 | $85.11 |