- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,290.87 / $7,079.46
| Facility | | $398.11 | $2,290.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $1,047.13
| Professional | | $281.84 | $389.05 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $891.25 / $2,290.87
| Professional | 50 | $407.38 | $891.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $309.03 / $912.01 / $912.01
| Professional | 54 | $309.03 | $912.01 | $912.01 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $426.58 / $602.56
| Professional | | $288.40 | $426.58 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $912.01
| Professional | 50 | $436.52 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $338.84 / $2,754.23
| Professional | | $288.40 | $338.84 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- 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
- $275.42 / $371.54 / $616.60
| Professional | | $275.42 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $489.78
| Professional | | $269.15 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $346.74
| Professional | | $338.84 | $338.84 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $616.60
| Facility | | $281.84 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $3,311.31
| Facility | | $245.47 | $389.05 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $3,311.31
| Professional | | $251.19 | $416.87 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,905.46 / $3,890.45
| Facility | | $977.24 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $309.03 / $575.44
| Professional | | $229.09 | $309.03 | $575.44 |