- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $407.38 / $4,365.16
| Facility | | $97.72 | $407.38 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $28.18 / $72.44
| Professional | | $14.13 | $28.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $21.38 / $60.26 / $107.15
| Professional | 50 | $21.38 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.95 / $69.18 / $69.18
| Professional | 52 | $19.95 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $16.98 / $64.57 / $64.57
| Professional | 53 | $16.98 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.14 / $25.12
| Professional | | $14.13 | $15.14 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $33.88
| Professional | 50 | $22.91 | $26.92 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $20.42 / $26.30
| Professional | | $15.85 | $20.42 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $26.92
| Professional | 50 | $20.89 | $24.55 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $23.44
| Professional | | $11.22 | $15.85 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $11.48 / $27.54
| Professional | | $0.21 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.18 / $25.70
| Professional | | $0.18 | $0.18 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $16.98
| Professional | | $15.14 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $1,047.13 / $2,041.74
| Facility | | $120.23 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $42.66
| Professional | | $12.88 | $18.20 | $42.66 |