- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,691.53 / $3,715.35
| Facility | | $338.84 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $398.11 / $831.76
| Professional | | $309.03 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $1,047.13
| Professional | 50 | $407.38 | $602.56 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $309.03 / $512.86 / $575.44
| Professional | 54 | $309.03 | $512.86 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,698.24 / $28,840.32
| Facility | | $741.31 | $1,698.24 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 54 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 55 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $1,071.52
| Professional | | $257.04 | $436.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $851.14
| Facility | | $371.54 | $371.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $630.96 / $851.14
| Professional | | $371.54 | $630.96 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $1,023.29
| Professional | 50 | $549.54 | $549.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $602.56
| Professional | 54 | $281.84 | $446.68 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $181.97
| Professional | 55 | $79.43 | $134.90 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $562.34 / $1,047.13
| Professional | | $281.84 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $3,630.78
| Facility | | $288.40 | $407.38 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $457.09 / $588.84
| Professional | | $380.19 | $457.09 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,511.89 / $7,079.46
| Facility | | $1,148.15 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $478.63 / $912.01
| Professional | | $331.13 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $3,890.45
| Facility | | $302.00 | $302.00 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $602.56
| Professional | | $346.74 | $467.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,698.24 / $28,840.32
| Facility | | $741.31 | $1,698.24 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 54 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 55 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $1,071.52
| Professional | | $257.04 | $436.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $295.12 / $588.84
| Professional | | $158.49 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,041.74 / $5,623.41
| Facility | | $776.25 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $446.68 / $933.25
| Professional | | $295.12 | $446.68 | $933.25 |