- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,174.90 / $3,467.37
| Facility | | $218.78 | $1,174.90 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,202.26 / $1,905.46 / $3,162.28
| Facility | 50 | $1,202.26 | $1,905.46 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $213.80 / $562.34
| Professional | | $107.15 | $213.80 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $1,023.29
| Professional | 50 | $151.36 | $302.00 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $37.15
| Professional | 53 | $36.31 | $36.31 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $295.12
| Professional | | $93.33 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $162.18 / $407.38
| Professional | 50 | $141.25 | $162.18 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,230.27 / $1,949.84
| Facility | | $407.38 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $371.54
| Professional | | $117.49 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $741.31 / $741.31
| Facility | | $39.81 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $380.19
| Professional | | $123.03 | $223.87 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,096.48 / $2,454.71
| Facility | | $338.84 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $204.17 / $407.38
| Professional | | $102.33 | $204.17 | $407.38 |