- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $741.31 / $6,606.93
| Facility | | $467.74 | $741.31 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | 50 | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $954.99
| Professional | | $245.47 | $354.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $512.86 / $1,737.80
| Professional | 50 | $338.84 | $512.86 | $1,737.80 |
- 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
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $794.33
| Professional | | $295.12 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $724.44
| Professional | | $380.19 | $501.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $741.31
| Facility | | $275.42 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | 50 | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $512.86 / $776.25
| Professional | | $338.84 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $512.86 / $1,737.80
| Professional | 50 | $338.84 | $512.86 | $1,737.80 |
- 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
- $363.08 / $562.34 / $602.56
| Facility | | $363.08 | $562.34 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $467.74 / $741.31
| Facility | | $281.84 | $467.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $524.81 / $741.31
| Professional | | $79.43 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,995.26 / $2,290.87
| Facility | | $1,412.54 | $1,995.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $3,019.95 / $3,388.44
| Facility | 50 | $2,137.96 | $3,019.95 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $812.83
| Professional | | $426.58 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,398.83 / $4,897.79
| Facility | | $1,548.82 | $2,398.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $758.58
| Professional | | $346.74 | $501.19 | $758.58 |