- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $2,290.87 / $6,456.54
| Facility | | $117.49 | $2,290.87 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $204.17 / $489.78
| Professional | | $77.62 | $204.17 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $309.03 / $380.19
| Professional | 50 | $120.23 | $309.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $263.03 / $660.69
| Professional | | $138.04 | $263.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $257.04 / $831.76
| Professional | | $87.10 | $257.04 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $416.87 / $2,951.21
| Facility | | $134.90 | $416.87 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 52 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $380.19 / $707.95
| Professional | | $194.98 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $562.34
| Professional | | $194.98 | $478.63 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $562.34 / $812.83
| Professional | | $204.17 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $177.83 / $478.63
| Professional | | $75.86 | $177.83 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,862.09 / $5,128.61
| Facility | | $1,023.29 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $208.93 / $524.81
| Professional | | $85.11 | $208.93 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $331.13 / $489.78
| Professional | | $158.49 | $331.13 | $489.78 |