- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $3,630.78
| Facility | | $316.23 | $588.84 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 50 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $776.25
| Professional | | $288.40 | $363.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $870.96 / $933.25
| Professional | 50 | $467.74 | $870.96 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $794.33
| Professional | | $562.34 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $851.14 / $1,000.00 / $1,202.26
| Professional | 50 | $851.14 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $562.34
| Professional | 54 | $398.11 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $645.65 / $977.24
| Professional | | $288.40 | $645.65 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $707.95
| Facility | | $316.23 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $616.60 / $2,344.23
| Professional | | $323.59 | $616.60 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $977.24 / $1,288.25
| Professional | 50 | $645.65 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | 54 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $2,570.40
| Facility | | $676.08 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $851.14
| Professional | | $275.42 | $524.81 | $851.14 |