- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,951.21 / $8,511.38
| Facility | | $316.23 | $2,951.21 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $758.58
| Professional | | $208.93 | $323.59 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $1,174.90
| Professional | 50 | $407.38 | $588.84 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $707.95
| Professional | | $199.53 | $251.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $380.19 / $1,047.13
| Professional | 50 | $302.00 | $380.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $2,398.83 / $10,964.78
| Facility | | $288.40 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $346.74
| Professional | | $288.40 | $288.40 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $338.84 / $53,703.18
| Facility | | $34.67 | $338.84 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | 54 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $346.74 / $851.14
| Professional | | $194.98 | $346.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $660.69
| Facility | | $199.53 | $323.59 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $512.86
| Professional | | $281.84 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $512.86
| Professional | | $190.55 | $302.00 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $467.74
| Professional | 54 | $173.78 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $19.05 / $31.62 / $51.29
| Professional | 55 | $19.05 | $31.62 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | 50 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $302.00
| Professional | | $213.80 | $251.19 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $446.68 / $457.09 / $457.09
| Professional | 50 | $446.68 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $50,118.72 / $75,857.76
| Facility | | $645.65 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $549.54
| Professional | | $288.40 | $363.08 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $5,248.07
| Facility | | $1,348.96 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $645.65
| Professional | | $177.83 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $275.42 / $912.01
| Facility | | $165.96 | $275.42 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $251.19
| Facility | 54 | $151.36 | $213.80 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $831.76
| Professional | | $190.55 | $302.00 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $467.74
| Professional | 54 | $173.78 | $251.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $51.29
| Professional | 55 | $19.05 | $30.20 | $51.29 |