- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $467.74 / $2,691.53
| Facility | | $74.13 | $467.74 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $22.39 / $44.67
| Professional | | $12.88 | $22.39 | $44.67 |
- 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
- $16.22 / $16.22 / $38.90
| Professional | 52 | $16.22 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Professional | 53 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $18.62 / $24.55
| Professional | | $11.48 | $18.62 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $37.15
| Professional | 50 | $20.42 | $27.54 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,445.44 / $2,041.74
| Facility | | $676.08 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.62 / $32.36
| Professional | | $13.49 | $18.62 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $27.54
| Professional | | $12.88 | $17.78 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $97.72 / $97.72
| Facility | | $54.95 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $134.90 / $134.90
| Professional | | $112.20 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $812.83 / $2,344.23
| Facility | | $229.09 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $17.78 / $28.84
| Professional | | $12.59 | $17.78 | $28.84 |