- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $3,162.28 / $7,413.10
| Facility | | $426.58 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $398.11 / $707.95
| Professional | | $288.40 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $870.96 / $1,380.38
| Professional | 50 | $407.38 | $870.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $676.08
| Professional | 54 | $309.03 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $389.05
| Professional | 55 | $63.10 | $63.10 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $575.44
| Professional | | $295.12 | $467.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $977.24
| Professional | 50 | $457.09 | $537.03 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,089.30 / $3,981.07
| Facility | | $741.31 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $380.19 / $562.34
| Professional | | $239.88 | $380.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $851.14
| Professional | 50 | $363.08 | $588.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $371.54 / $436.52
| Facility | | $288.40 | $371.54 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $426.58
| Professional | | $416.87 | $416.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $407.38 / $549.54
| Facility | | $371.54 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $407.38 / $794.33
| Professional | | $281.84 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $446.68 / $1,096.48
| Professional | | $323.59 | $446.68 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $371.54 / $398.11 / $616.60
| Professional | 54 | $371.54 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $26.30 / $28.18 / $43.65
| Professional | 55 | $26.30 | $28.18 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $758.58
| Professional | | $380.19 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,949.84 / $2,951.21
| Facility | | $407.38 | $1,949.84 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $707.95
| Professional | | $281.84 | $389.05 | $707.95 |