- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $2,951.21 / $7,413.10
| Facility | | $407.38 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | 50 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $831.76
| Professional | | $281.84 | $371.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $616.60 / $933.25
| Professional | 50 | $436.52 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $707.95
| Professional | 54 | $234.42 | $309.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $61.66
| Professional | 55 | $53.70 | $53.70 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $851.14
| Professional | | $269.15 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $512.86 / $1,258.93
| Professional | 50 | $407.38 | $512.86 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,698.24 / $6,165.95
| Facility | | $436.52 | $1,698.24 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $467.74
| Professional | | $436.52 | $436.52 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,862.09 / $53,703.18
| Facility | | $407.38 | $1,862.09 | $53,703.18 |
- 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 / $457.09 / $1,122.02
| Professional | | $269.15 | $457.09 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $346.74 / $1,047.13
| Facility | | $251.19 | $346.74 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $630.96
| Professional | | $208.93 | $295.12 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $831.76
| Professional | | $263.03 | $537.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $204.17 / $549.54 / $776.25
| Professional | 54 | $204.17 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $141.25
| Professional | 55 | $52.48 | $85.11 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $407.38
| Professional | | $288.40 | $380.19 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $512.86 / $616.60 / $616.60
| Professional | 50 | $512.86 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $50,118.72 / $75,857.76
| Facility | | $281.84 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $407.38 / $676.08
| Professional | | $389.05 | $407.38 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,884.03 / $5,248.07
| Facility | | $1,348.96 | $2,884.03 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $588.84
| Professional | | $165.96 | $269.15 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $812.83
| Facility | | $251.19 | $426.58 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $338.84
| Facility | 54 | $204.17 | $204.17 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 55
- Typical Low / Median / Typical High
- $50.12 / $56.23 / $85.11
| Facility | 55 | $50.12 | $56.23 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $1,258.93
| Professional | | $263.03 | $537.03 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $204.17 / $436.52 / $724.44
| Professional | 54 | $204.17 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $165.96
| Professional | 55 | $52.48 | $79.43 | $165.96 |