- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $512.86 / $6,456.54
| Facility | | $41.69 | $512.86 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $263.03 / $3,019.95
| Facility | 50 | $67.61 | $263.03 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $75.86
| Facility | 52 | $30.90 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $54.95 / $120.23
| Professional | | $30.20 | $54.95 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $102.33 / $223.87
| Professional | 50 | $54.95 | $102.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $9.55 / $34.67 / $66.07
| Professional | 52 | $9.55 | $34.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $46.77 / $72.44
| Professional | | $37.15 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $125.89
| Professional | 50 | $54.95 | $69.18 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $4,265.80 / $12,302.69
| Facility | | $52.48 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $53.70
| Professional | | $30.90 | $39.81 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- 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
- $32.36 / $52.48 / $89.13
| Professional | | $32.36 | $52.48 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,041.74 / $3,388.44
| Facility | | $1,412.54 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $61.66
| Professional | | $33.11 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $58.88
| Professional | | $24.55 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,445.44 / $3,630.78
| Facility | | $186.21 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $89.13
| Professional | | $30.20 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | 50 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $50.12
| Professional | | $21.38 | $24.55 | $50.12 |