- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,238.72 / $5,370.32
| Facility | | $537.03 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $891.25
| Facility | 50 | $741.31 | $870.96 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 54 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $831.76
| Professional | | $295.12 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $489.78 / $2,187.76
| Professional | 50 | $346.74 | $489.78 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $912.01
| Professional | 54 | $245.47 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $58.88 / $63.10 / $389.05
| Professional | 55 | $58.88 | $63.10 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $741.31 / $912.01
| Professional | | $275.42 | $741.31 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $851.14
| Professional | | $239.88 | $398.11 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $831.76 / $3,235.94
| Facility | | $446.68 | $831.76 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 54 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 55 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $724.44 / $2,344.23
| Professional | | $354.81 | $724.44 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Professional | 54 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $870.96
| Professional | | $537.03 | $758.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $691.83
| Professional | | $275.42 | $501.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,548.82 / $5,128.61
| Facility | | $794.33 | $1,548.82 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $891.25
| Professional | | $288.40 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $630.96 / $741.31
| Professional | | $489.78 | $630.96 | $741.31 |