- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $691.83 / $3,630.78
| Facility | | $331.13 | $691.83 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $1,122.02
| Facility | 50 | $741.31 | $870.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 54 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $870.96
| Professional | | $295.12 | $371.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $562.34 / $1,148.15
| Professional | 50 | $467.74 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $645.65
| Professional | 54 | $380.19 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | 55 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $630.96 / $707.95
| Professional | | $309.03 | $630.96 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $977.24
| Professional | | $645.65 | $794.33 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $851.14
| Facility | | $251.19 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $602.56 / $2,344.23
| Professional | | $288.40 | $602.56 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $912.01
| Professional | 50 | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $758.58 / $794.33
| Professional | | $724.44 | $758.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $660.69
| Professional | | $354.81 | $549.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $602.56 / $891.25
| Professional | | $288.40 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $707.95 / $758.58
| Professional | | $588.84 | $707.95 | $758.58 |