- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $1,513.56 / $6,606.93
| Facility | | $52.48 | $1,513.56 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $34.67
| Professional | | $12.88 | $15.85 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.95 / $22.39 / $44.67
| Professional | 50 | $19.95 | $22.39 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $15.14 / $19.50
| Professional | | $11.48 | $15.14 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $30.90
| Professional | 50 | $22.91 | $27.54 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $218.78
| Facility | | $109.65 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $16.98 / $18.62
| Professional | | $13.80 | $16.98 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $16.22 / $20.89
| Professional | | $13.49 | $16.22 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $398.11 / $2,570.40
| Facility | | $13.80 | $398.11 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $117.49
| Professional | | $12.02 | $15.85 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $549.54 / $1,548.82
| Facility | | $89.13 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $21.38
| Professional | | $11.48 | $14.79 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $85.11 / $85.11
| Professional | 50 | $33.11 | $85.11 | $85.11 |