- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $213.80 / $7,943.28
| Facility | | $47.86 | $213.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.99 / $51.29
| Professional | | $12.59 | $23.99 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $20.42 / $39.81 / $83.18
| Professional | 50 | $20.42 | $39.81 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $14.13 / $16.22 / $38.90
| Professional | 52 | $14.13 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $16.98
| Professional | 53 | $6.17 | $6.17 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $21.88
| Professional | | $13.49 | $19.50 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Professional | 50 | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $154.88
| Facility | | $50.12 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $21.88
| Professional | | $10.96 | $15.85 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $30.20
| Professional | | $15.14 | $16.98 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $32.36
| Facility | | $13.80 | $18.62 | $32.36 |
- 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
- $199.53 / $1,096.48 / $4,677.35
| Facility | | $199.53 | $1,096.48 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $26.92
| Professional | | $11.48 | $16.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |