- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $831.76
| Facility | | $229.09 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $602.56 / $724.44
| Professional | | $309.03 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,380.38
| Professional | 50 | $1,047.13 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $407.38 / $562.34
| Facility | | $331.13 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $645.65 / $776.25
| Professional | | $331.13 | $645.65 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $562.34 / $562.34
| Facility | | $34.67 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 54 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $426.58 / $1,698.24
| Professional | | $316.23 | $426.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $575.44 / $1,071.52
| Facility | | $194.98 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $575.44 / $776.25
| Professional | | $501.19 | $575.44 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $691.83
| Facility | | $457.09 | $457.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $549.54
| Professional | | $218.78 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 54 | $85.11 | $85.11 | $85.11 |