- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $169.82 / $3,467.37
| Facility | | $21.88 | $169.82 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $24.55 / $50.12
| Professional | | $12.88 | $24.55 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.50 / $40.74 / $123.03
| Professional | 50 | $19.50 | $40.74 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $13.80 / $29.51 / $53.70
| Professional | 52 | $13.80 | $29.51 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Professional | 53 | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $17.38 / $23.44
| Professional | | $12.30 | $17.38 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $33.11
| Professional | 50 | $18.62 | $28.18 | $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
- $501.19 / $4,466.84 / $8,709.64
| Facility | | $501.19 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $19.05 / $31.62
| Professional | | $11.22 | $19.05 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.98 / $28.84 / $47.86
| Professional | 50 | $16.98 | $28.84 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $17.38 / $19.50
| Facility | | $13.49 | $17.38 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $15.85 / $19.50
| Professional | | $13.80 | $15.85 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $17.78 / $23.44
| Facility | | $13.49 | $17.78 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $30.20
| Professional | | $13.49 | $18.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $2,238.72 / $7,413.10
| Facility | | $50.12 | $2,238.72 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.79 / $26.30
| Professional | | $11.22 | $14.79 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |