- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $3,467.37 / $7,413.10
| Facility | | $575.44 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,202.26 / $1,412.54
| Facility | 50 | $1,071.52 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $691.83
| Professional | | $257.04 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $436.52 / $1,023.29
| Professional | 50 | $331.13 | $436.52 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $575.44
| Professional | 54 | $223.87 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $9.33 / $56.23 / $79.43
| Professional | 55 | $9.33 | $56.23 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $288.40
| Professional | | $117.49 | $204.17 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,318.26
| Facility | | $645.65 | $870.96 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $616.60
| Professional | | $501.19 | $501.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $630.96
| Professional | | $295.12 | $426.58 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $3,981.07
| Facility | | $346.74 | $512.86 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $380.19 / $2,511.89
| Professional | | $302.00 | $380.19 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $2,570.40
| Facility | | $407.38 | $660.69 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $371.54 / $524.81
| Professional | | $288.40 | $371.54 | $524.81 |