- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $912.01 / $5,495.41
| Facility | | $457.09 | $912.01 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 50 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $954.99
| Professional | | $288.40 | $407.38 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $3,801.89
| Professional | 50 | $380.19 | $489.78 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $912.01
| Professional | 54 | $295.12 | $346.74 | $912.01 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $851.14 / $1,513.56
| Facility | | $380.19 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $575.44 / $1,288.25 / $2,238.72
| Facility | 50 | $575.44 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $602.56 / $660.69
| Professional | | $489.78 | $602.56 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $758.58 / $870.96 / $954.99
| Professional | 50 | $758.58 | $870.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $588.84
| Professional | 54 | $457.09 | $537.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $51.29 / $58.88 / $66.07
| Professional | 55 | $51.29 | $58.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $446.68 / $562.34
| Professional | | $257.04 | $446.68 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $562.34 / $1,047.13
| Facility | | $275.42 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 50 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $741.31
| Professional | | $302.00 | $524.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $489.78 / $1,819.70
| Professional | 50 | $331.13 | $489.78 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $912.01
| Professional | 54 | $295.12 | $346.74 | $912.01 |
- 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
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,318.26 / $1,862.09
| Facility | | $1,047.13 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,584.89 / $2,089.30 / $2,754.23
| Facility | 50 | $1,584.89 | $2,089.30 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $616.60 / $691.83
| Professional | | $467.74 | $616.60 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $831.76
| Professional | | $295.12 | $501.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $4,168.69 / $4,466.84
| Facility | | $346.74 | $4,168.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $616.60
| Professional | | $288.40 | $436.52 | $616.60 |