- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $630.96 / $5,248.07
| Facility | | $338.84 | $630.96 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $371.54 / $575.44
| Professional | | $288.40 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $1,047.13
| Professional | 50 | $407.38 | $467.74 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $338.84
| Professional | 54 | $218.78 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | 55 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $323.59
| Professional | | $208.93 | $288.40 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,398.83 / $4,265.80
| Facility | | $1,412.54 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $257.04 / $416.87
| Professional | | $218.78 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $616.60
| Professional | 50 | $331.13 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $371.54 / $416.87
| Facility | | $275.42 | $371.54 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $446.68
| Professional | | $295.12 | $346.74 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $1,862.09
| Facility | | $512.86 | $512.86 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | 54 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 55 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $1,548.82
| Professional | | $269.15 | $389.05 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $144.54
| Professional | | $32.36 | $33.11 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,445.44 / $2,630.27
| Facility | | $389.05 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $309.03 / $562.34
| Professional | | $251.19 | $309.03 | $562.34 |