- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $3,235.94 / $8,709.64
| Facility | | $660.69 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $3,801.89 / $9,120.11
| Facility | 50 | $630.96 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $371.54 / $645.65
| Professional | | $158.49 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $169.82 / $194.98
| Professional | | $66.07 | $169.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $288.40
| Professional | 50 | $213.80 | $257.04 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $5,495.41 / $8,709.64
| Facility | | $3,467.37 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $416.87 / $575.44
| Professional | | $151.36 | $416.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $588.84
| Professional | | $147.91 | $229.09 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $891.25 / $5,495.41
| Facility | | $186.21 | $891.25 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | 52 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | 53 | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $4,677.35
| Professional | | $389.05 | $537.03 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,951.21 / $6,456.54
| Facility | | $891.25 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $323.59 / $588.84
| Professional | | $144.54 | $323.59 | $588.84 |