- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,398.83 / $7,413.10
| Facility | | $724.44 | $2,398.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $724.44 / $1,584.89
| Professional | | $588.84 | $724.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $2,290.87 / $2,398.83
| Professional | 50 | $2,137.96 | $2,290.87 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $3,981.07
| Facility | | $676.08 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $1,023.29
| Professional | | $512.86 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $758.58 / $1,023.29 / $1,548.82
| Professional | 50 | $758.58 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $954.99
| Professional | | $524.81 | $724.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $588.84
| Facility | | $389.05 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $812.83 / $1,318.26
| Professional | | $478.63 | $812.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,445.44 / $12,022.64
| Facility | | $630.96 | $1,445.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 54 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $5,128.61
| Professional | | $630.96 | $954.99 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,148.15 / $2,691.53
| Facility | | $794.33 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $707.95 / $1,174.90
| Professional | | $549.54 | $707.95 | $1,174.90 |