- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,511.89 / $6,760.83
| Facility | | $407.38 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $776.25
| Professional | | $239.88 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $1,023.29 / $2,691.53
| Professional | 50 | $478.63 | $1,023.29 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $616.60 / $812.83
| Professional | | $331.13 | $616.60 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $1,148.15
| Professional | | $208.93 | $354.81 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $758.58 / $3,235.94
| Facility | | $363.08 | $758.58 | $3,235.94 |
- 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
- $363.08 / $630.96 / $1,548.82
| Professional | | $363.08 | $630.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $812.83
| Professional | | $549.54 | $691.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $371.54 / $616.60
| Professional | | $204.17 | $371.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,621.81 / $5,128.61
| Facility | | $794.33 | $1,621.81 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $812.83
| Professional | | $245.47 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $660.69
| Professional | | $436.52 | $512.86 | $660.69 |