- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $354.81 / $1,995.26
| Facility | | $316.23 | $354.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $549.54 / $741.31
| Professional | | $263.03 | $549.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | 50 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $794.33
| Professional | 54 | $281.84 | $380.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $891.25
| Professional | | $630.96 | $758.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $1,122.02 / $1,348.96
| Professional | 50 | $933.25 | $1,122.02 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $436.52 / $524.81 / $630.96
| Professional | 54 | $436.52 | $524.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $741.31 / $1,122.02
| Professional | | $323.59 | $741.31 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $616.60
| Facility | | $316.23 | $436.52 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $616.60 / $2,511.89
| Professional | | $338.84 | $616.60 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,819.70 / $2,041.74
| Facility | | $489.78 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $602.56 / $891.25
| Professional | | $275.42 | $602.56 | $891.25 |