- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,148.15 / $7,244.36
| Facility | | $398.11 | $1,148.15 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $10,715.19
| Facility | 50 | $1,445.44 | $1,445.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $371.54 / $794.33
| Professional | | $288.40 | $371.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $1,698.24
| Professional | 50 | $416.87 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $707.95
| Professional | 54 | $251.19 | $363.08 | $707.95 |
- 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
- $288.40 / $323.59 / $407.38
| Professional | | $288.40 | $323.59 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | 50 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $1,047.13
| Professional | | $218.78 | $380.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $707.95
| Professional | | $263.03 | $389.05 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $630.96
| Facility | | $295.12 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $794.33
| Facility | | $758.58 | $758.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $467.74 / $524.81
| Professional | | $436.52 | $467.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,137.96 / $4,265.80
| Facility | | $891.25 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $707.95
| Professional | | $245.47 | $323.59 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $28,840.32
| Facility | | $1,995.26 | $1,995.26 | $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
- $2,398.83 / $2,398.83 / $2,754.23
| Professional | | $2,398.83 | $2,398.83 | $2,754.23 |