- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,344.23 / $8,128.31
| Facility | | $338.84 | $2,344.23 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $851.14 / $870.96 / $1,380.38
| Facility | 50 | $851.14 | $870.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $93.33 / $208.93
| Professional | | $54.95 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $213.80 / $512.86
| Professional | 50 | $112.20 | $213.80 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $131.83
| Professional | | $57.54 | $91.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $199.53
| Professional | 50 | $107.15 | $141.25 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $4,168.69 / $12,302.69
| Facility | | $79.43 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $93.33
| Professional | | $53.70 | $70.79 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $53.70 / $323.59
| Facility | | $44.67 | $53.70 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $147.91
| Professional | | $56.23 | $89.13 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $91.20
| Professional | | $40.74 | $66.07 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $114.82
| Professional | | $32.36 | $43.65 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,445.44 / $3,630.78
| Facility | | $263.03 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $128.82
| Professional | | $47.86 | $70.79 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $93.33
| Professional | | $43.65 | $64.57 | $93.33 |