- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $223.87 / $3,801.89
| Facility | | $13.49 | $223.87 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $57.54
| Professional | | $12.59 | $22.39 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $213.80
| Professional | 50 | $21.38 | $41.69 | $213.80 |
- 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
- $14.79 / $18.20 / $21.38
| Professional | | $14.79 | $18.20 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $31.62
| Professional | 50 | $19.50 | $23.99 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $11.48 / $16.22
| Professional | | $9.77 | $11.48 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $14.79 / $17.38 / $23.99
| Professional | 50 | $14.79 | $17.38 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.62 / $23.99
| Facility | | $13.49 | $18.62 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $17.38 / $21.38
| Professional | | $13.49 | $17.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $24.55 / $34.67
| Facility | | $22.39 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $21.38 / $72.44
| Professional | | $13.49 | $21.38 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $724.44 / $1,949.84
| Facility | | $50.12 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $25.70
| Professional | | $11.22 | $15.14 | $25.70 |