- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $2,511.89 / $5,623.41
| Facility | | $371.54 | $2,511.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $724.44 / $851.14 / $1,202.26
| Facility | 50 | $724.44 | $851.14 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $741.31
| Professional | | $281.84 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $1,023.29
| Professional | 50 | $407.38 | $602.56 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $549.54
| Professional | 54 | $223.87 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $57.54 / $60.26 / $389.05
| Professional | 55 | $57.54 | $60.26 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $288.40 / $380.19
| Professional | | $204.17 | $288.40 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,862.09 / $6,025.60
| Facility | | $676.08 | $1,862.09 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $588.84
| Professional | | $263.03 | $346.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $870.96
| Professional | 50 | $398.11 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $489.78
| Professional | | $281.84 | $346.74 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $512.86
| Facility | | $323.59 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $645.65
| Professional | | $263.03 | $407.38 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $831.76 / $16,218.10
| Facility | | $331.13 | $831.76 | $16,218.10 |
- 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
- $302.00 / $457.09 / $2,511.89
| Professional | | $302.00 | $457.09 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $524.81 / $588.84
| Professional | 50 | $478.63 | $524.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $416.87
| Professional | 54 | $288.40 | $288.40 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,047.13 / $2,089.30
| Facility | | $436.52 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $354.81 / $588.84
| Professional | | $275.42 | $354.81 | $588.84 |