- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $812.83 / $1,862.09
| Facility | | $354.81 | $812.83 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | 50 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $676.08
| Professional | | $269.15 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $1,023.29
| Professional | 50 | $407.38 | $467.74 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $389.05
| Professional | 54 | $213.80 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $9.33 / $72.44 / $79.43
| Professional | 55 | $9.33 | $72.44 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $741.31
| Facility | | $537.03 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $354.81 / $467.74
| Professional | | $331.13 | $354.81 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $616.60
| Professional | | $302.00 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $645.65
| Professional | | $288.40 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $977.24
| Professional | 50 | $426.58 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $891.25 / $1,621.81
| Facility | | $331.13 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $588.84
| Professional | | $263.03 | $338.84 | $588.84 |