- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $1,122.02
| Professional | | $251.19 | $398.11 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $2,691.53
| Professional | 50 | $446.68 | $446.68 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $380.19
| Professional | 54 | $275.42 | $275.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $724.44 / $1,513.56
| Facility | | $331.13 | $724.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $1,096.48 / $2,238.72
| Facility | 50 | $489.78 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $588.84
| Professional | | $389.05 | $467.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $724.44 / $870.96
| Professional | 50 | $602.56 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $346.74 / $416.87 / $524.81
| Professional | 54 | $346.74 | $416.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $58.88
| Professional | 55 | $38.90 | $46.77 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $371.54 / $512.86
| Professional | | $234.42 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $524.81 / $977.24
| Facility | | $251.19 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $660.69
| Professional | | $263.03 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $2,691.53
| Professional | 50 | $446.68 | $446.68 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $380.19
| Professional | 54 | $275.42 | $275.42 | $380.19 |
- 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
- $389.05 / $489.78 / $616.60
| Professional | | $389.05 | $489.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $812.83
| Professional | | $208.93 | $389.05 | $812.83 |
- 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
- $269.15 / $389.05 / $537.03
| Professional | | $269.15 | $389.05 | $537.03 |