- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,513.56 / $6,918.31
| Facility | | $416.87 | $1,513.56 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $794.33
| Professional | | $269.15 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $1,122.02 / $1,380.38
| Professional | 50 | $616.60 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $676.08
| Professional | 54 | $263.03 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $758.58
| Professional | | $323.59 | $467.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $4,168.69 / $12,302.69
| Facility | | $257.04 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $389.05
| Professional | | $251.19 | $338.84 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $138.04 / $562.34
| Facility | | $128.82 | $138.04 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 54 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $630.96
| Professional | | $263.03 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $389.05
| Professional | | $151.36 | $275.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $288.40 / $562.34
| Professional | | $32.36 | $288.40 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,445.44 / $3,630.78
| Facility | | $251.19 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $602.56
| Professional | | $218.78 | $316.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $89.13
| Professional | 54 | $85.11 | $85.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $275.42 / $407.38
| Professional | | $263.03 | $275.42 | $407.38 |