- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $912.01 / $1,348.96
| Facility | | $10.23 | $912.01 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $616.60
| Professional | | $275.42 | $346.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $354.81 / $467.74
| Facility | | $316.23 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $331.13 / $707.95
| Professional | | $295.12 | $331.13 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $1,862.09
| Facility | | $512.86 | $512.86 | $1,862.09 |
- 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
- $234.42 / $380.19 / $1,548.82
| Professional | | $234.42 | $380.19 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,513.56 / $2,290.87
| Facility | | $741.31 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,041.74 / $2,089.30 / $2,570.40
| Facility | 50 | $2,041.74 | $2,089.30 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $489.78 / $707.95
| Professional | | $416.87 | $489.78 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $741.31 / $1,071.52
| Professional | 50 | $676.08 | $741.31 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $323.59 / $489.78 / $588.84
| Professional | 54 | $323.59 | $489.78 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,548.82
| Facility | | $691.83 | $691.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $295.12 / $457.09
| Professional | | $229.09 | $295.12 | $457.09 |