- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $977.24
| Professional | | $229.09 | $338.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $1,023.29 / $2,691.53
| Professional | 50 | $338.84 | $1,023.29 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,454.71 / $4,570.88
| Facility | | $549.54 | $2,454.71 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $1,548.82
| Professional | | $213.80 | $269.15 | $1,548.82 |
- 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
- $239.88 / $346.74 / $549.54
| Professional | | $239.88 | $346.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $2,691.53
| Facility | | $245.47 | $457.09 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | 54 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $2,818.38
| Professional | | $281.84 | $389.05 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | 50 | $331.13 | $331.13 | $331.13 |
- 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
- $229.09 / $316.23 / $512.86
| Professional | | $229.09 | $316.23 | $512.86 |