- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $3,715.35 / $7,413.10
| Facility | | $977.24 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | 50 | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $831.76 / $3,388.44
| Professional | | $426.58 | $831.76 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | 50 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $389.05 / $524.81 / $707.95
| Professional | 54 | $389.05 | $524.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 55
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $141.25
| Professional | 55 | $75.86 | $102.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,890.45 / $6,025.60
| Facility | | $2,137.96 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $660.69 / $851.14
| Professional | | $562.34 | $660.69 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $1,698.24 / $1,698.24
| Facility | | $39.81 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $912.01
| Professional | | $338.84 | $660.69 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $2,754.23 / $6,309.57
| Facility | | $831.76 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $1,258.93
| Professional | | $446.68 | $630.96 | $1,258.93 |