- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $1,621.81 / $6,760.83
| Facility | | $501.19 | $1,621.81 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,621.81
| Facility | 50 | $1,445.44 | $1,445.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $251.19
| Professional | | $120.23 | $144.54 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $151.36 / $177.83
| Professional | | $138.04 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $181.97
| Professional | | $131.83 | $165.96 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $190.55 / $234.42
| Professional | | $144.54 | $190.55 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $524.81 / $2,570.40
| Facility | | $117.49 | $524.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 50 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | AS | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $165.96 / $977.24
| Professional | | $123.03 | $165.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $602.56 / $1,584.89
| Facility | | $138.04 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $223.87
| Professional | | $117.49 | $158.49 | $223.87 |