- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $2,691.53 / $7,413.10
| Facility | | $346.74 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $10,471.29
| Facility | 50 | $891.25 | $891.25 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $933.25
| Professional | | $245.47 | $354.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $794.33
| Professional | 50 | $338.84 | $446.68 | $794.33 |
- 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
- $245.47 / $309.03 / $794.33
| Professional | | $245.47 | $309.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $1,174.90
| Professional | 50 | $371.54 | $467.74 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,995.26 / $8,912.51
| Facility | | $331.13 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $426.58
| Professional | | $331.13 | $331.13 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $389.05 / $53,703.18
| Facility | | $34.67 | $389.05 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 54 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $1,000.00
| Professional | | $229.09 | $407.38 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $354.81 / $776.25
| Facility | | $234.42 | $354.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $616.60
| Professional | | $302.00 | $416.87 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $630.96
| Professional | | $234.42 | $316.23 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $562.34
| Professional | 54 | $199.53 | $338.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $63.10
| Professional | 55 | $23.44 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,995.26 / $2,137.96
| Facility | | $645.65 | $1,995.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $371.54
| Professional | | $275.42 | $346.74 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $562.34
| Professional | 50 | $549.54 | $549.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | 54 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $50,118.72 / $75,857.76
| Facility | | $380.19 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $602.56
| Professional | | $354.81 | $398.11 | $602.56 |
- 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
- $208.93 / $338.84 / $741.31
| Professional | | $208.93 | $338.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $323.59 / $1,096.48
| Facility | | $190.55 | $323.59 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $288.40
| Facility | 54 | $173.78 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $1,096.48
| Professional | | $234.42 | $309.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $562.34
| Professional | 54 | $199.53 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $63.10
| Professional | 55 | $23.44 | $32.36 | $63.10 |