- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $120.23 / $2,041.74
| Facility | | $19.50 | $120.23 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $20.89 / $48.98
| Professional | | $12.59 | $20.89 | $48.98 |
- 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
- $12.30 / $13.80 / $53.70
| Professional | 52 | $12.30 | $13.80 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $6.46 / $7.94 / $8.13
| Professional | 53 | $6.46 | $7.94 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $15.49 / $16.60
| Professional | | $13.18 | $15.49 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.50 / $25.12 / $39.81
| Professional | 50 | $19.50 | $25.12 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $35.48
| Professional | | $23.44 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | 50 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $14.45
| Facility | | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.22 / $46.77
| Professional | | $12.88 | $16.22 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $97.72 / $2,041.74
| Facility | | $19.05 | $97.72 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $38.90
| Professional | | $12.30 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.95 / $37.15 / $91.20
| Professional | 50 | $19.95 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.30 / $12.59 / $53.70
| Professional | 52 | $12.30 | $12.59 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $6.46 / $7.94 / $8.13
| Professional | 53 | $6.46 | $7.94 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.49 / $21.38
| Professional | | $10.47 | $15.49 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $302.00 / $1,698.24
| Facility | | $46.77 | $302.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $15.85 / $24.55
| Professional | | $13.18 | $15.85 | $24.55 |