- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $354.81 / $5,623.41
| Facility | | $47.86 | $354.81 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $354.81 / $3,311.31
| Facility | 50 | $72.44 | $354.81 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $776.25
| Facility | 52 | $30.90 | $85.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $57.54 / $138.04
| Professional | | $30.20 | $57.54 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $42.66 / $134.90 / $239.88
| Professional | 22 | $42.66 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $295.12
| Professional | 50 | $56.23 | $104.71 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $151.36
| Professional | 52 | $29.51 | $42.66 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $3,801.89 / $9,549.93
| Facility | | $1,548.82 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $51.29 / $97.72
| Professional | | $26.30 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $141.25
| Professional | 50 | $34.67 | $75.86 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $151.36 / $416.87
| Facility | | $54.95 | $151.36 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | 52 | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $141.25
| Professional | | $36.31 | $61.66 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $977.24 / $3,311.31
| Facility | | $109.65 | $977.24 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $97.72
| Professional | | $30.90 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $177.83
| Professional | 50 | $79.43 | $79.43 | $177.83 |