- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $1,862.09
| Facility | | $251.19 | $323.59 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $933.25
| Professional | | $234.42 | $323.59 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $741.31 / $1,047.13
| Professional | 50 | $338.84 | $741.31 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,778.28 / $4,168.69
| Facility | | $724.44 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,288.25 / $2,137.96 / $5,888.44
| Facility | 50 | $1,288.25 | $2,137.96 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $588.84 / $1,023.29
| Professional | | $380.19 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $870.96 / $1,548.82
| Professional | 50 | $562.34 | $870.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $302.00 / $467.74 / $812.83
| Professional | 54 | $302.00 | $467.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $204.17
| Professional | 55 | $74.13 | $117.49 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $2,691.53
| Facility | | $794.33 | $1,122.02 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $776.25 / $1,258.93
| Professional | | $489.78 | $776.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,047.13 / $2,089.30
| Facility | | $851.14 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $741.31 / $1,202.26
| Professional | | $467.74 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $1,318.26
| Facility | | $316.23 | $512.86 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $549.54 / $1,778.28
| Professional | | $309.03 | $549.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $1,258.93 / $3,548.13
| Professional | 50 | $645.65 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,949.84 / $3,981.07
| Facility | | $1,023.29 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $977.24
| Professional | | $295.12 | $501.19 | $977.24 |