- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $295.12 / $3,235.94
| Facility | | $47.86 | $295.12 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $28.18 / $72.44
| Professional | | $12.88 | $28.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $21.38 / $44.67 / $107.15
| Professional | 50 | $21.38 | $44.67 | $107.15 |
- 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
- $7.94 / $8.32 / $64.57
| Professional | 53 | $7.94 | $8.32 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $141.25 / $2,818.38
| Facility | | $39.81 | $141.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $22.39 / $54.95
| Professional | | $12.30 | $22.39 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $44.67
| Professional | | $19.95 | $33.11 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $22.39
| Professional | 52 | $10.00 | $16.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $5.01 / $8.13 / $11.22
| Professional | 53 | $5.01 | $8.13 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $31.62 / $56.23
| Professional | | $17.78 | $31.62 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | 53 | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $3,630.78
| Facility | | $19.50 | $27.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $25.12 / $31.62
| Professional | | $19.50 | $25.12 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,041.74 / $3,467.37
| Facility | | $741.31 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $31.62 / $52.48
| Professional | | $17.38 | $31.62 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $263.03
| Facility | | $128.82 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $44.67
| Professional | | $29.51 | $35.48 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $141.25 / $2,818.38
| Facility | | $39.81 | $141.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $22.39 / $54.95
| Professional | | $12.30 | $22.39 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $16.60 / $32.36
| Professional | | $10.00 | $16.60 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,698.24 / $2,818.38
| Facility | | $154.88 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $27.54 / $53.70
| Professional | | $16.98 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |