- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,715.35 / $6,760.83
| Facility | | $1,737.80 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $851.14
| Professional | | $190.55 | $309.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $630.96 / $1,862.09
| Professional | 50 | $346.74 | $630.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,467.37 / $6,456.54
| Facility | | $776.25 | $3,467.37 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $1,348.96
| Professional | | $186.21 | $218.78 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $478.63
| Professional | | $199.53 | $281.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $2,691.53
| Facility | | $213.80 | $398.11 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | 54 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $4,466.84
| Professional | | $234.42 | $338.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $309.03
| Professional | 50 | $257.04 | $257.04 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,230.27 / $3,235.94
| Facility | | $467.74 | $1,230.27 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $426.58
| Professional | | $204.17 | $263.03 | $426.58 |