- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,621.81 / $5,495.41
| Facility | | $831.76 | $1,621.81 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $758.58
| Professional | | $234.42 | $323.59 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $691.83 / $1,513.56
| Facility | | $281.84 | $691.83 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $1,047.13 / $2,238.72
| Facility | 50 | $457.09 | $1,047.13 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $398.11 / $489.78
| Professional | | $331.13 | $398.11 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $724.44
| Professional | 50 | $467.74 | $588.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $436.52
| Professional | 54 | $295.12 | $371.54 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $48.98
| Professional | 55 | $33.88 | $39.81 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $416.87
| Professional | | $234.42 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $467.74 / $1,288.25
| Facility | | $204.17 | $467.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $537.03
| Professional | | $218.78 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,318.26 / $1,862.09
| Facility | | $1,047.13 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,584.89 / $2,089.30 / $2,754.23
| Facility | 50 | $1,584.89 | $2,089.30 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $512.86
| Professional | | $331.13 | $426.58 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $616.60
| Professional | | $186.21 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $4,168.69 / $4,466.84
| Facility | | $346.74 | $4,168.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $512.86
| Professional | | $257.04 | $354.81 | $512.86 |