- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $562.34 / $4,897.79
| Facility | | $213.80 | $562.34 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $851.14
| Professional | | $281.84 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,380.38
| Professional | 50 | $1,047.13 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $295.12 / $407.38 / $676.08
| Professional | 54 | $295.12 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $331.13 / $363.08
| Professional | | $316.23 | $331.13 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $457.09 / $602.56
| Professional | | $93.33 | $457.09 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $676.08
| Professional | 50 | $645.65 | $645.65 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $691.83
| Facility | | $380.19 | $489.78 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $446.68 / $776.25
| Professional | | $316.23 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $380.19 / $602.56
| Professional | | $263.03 | $380.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $794.33 / $4,897.79
| Facility | | $218.78 | $794.33 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $794.33
| Professional | | $302.00 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,380.38
| Professional | 50 | $1,047.13 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $467.74
| Professional | 54 | $295.12 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $575.44
| Professional | | $257.04 | $380.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $724.44 / $1,698.24
| Facility | | $194.98 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $354.81 / $501.19
| Professional | | $275.42 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 54 | $85.11 | $85.11 | $85.11 |