- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $912.01 / $5,888.44
| Facility | | $380.19 | $912.01 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,380.38
| Facility | 50 | $1,071.52 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $144.54 / $478.63
| Professional | | $46.77 | $144.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,096.48
| Professional | 50 | $478.63 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $169.82 / $467.74
| Professional | | $56.23 | $169.82 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $169.82 / $758.58
| Facility | | $52.48 | $169.82 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,380.38
| Facility | 50 | $1,071.52 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $223.87 / $630.96
| Professional | | $89.13 | $223.87 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $478.63 / $1,096.48
| Professional | 50 | $371.54 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $512.86 / $831.76
| Professional | | $199.53 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $151.36 / $346.74
| Facility | | $52.48 | $151.36 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $158.49 / $457.09
| Professional | | $60.26 | $158.49 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $213.80 / $426.58
| Professional | | $69.18 | $213.80 | $426.58 |