- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $288.40 / $758.58
| Facility | | $93.33 | $288.40 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $3,162.28 / $3,162.28
| Facility | 50 | $891.25 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $190.55 / $562.34
| Professional | | $56.23 | $190.55 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $208.93 / $512.86 / $1,096.48
| Professional | 50 | $208.93 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $263.03
| Professional | | $81.28 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $398.11
| Professional | 50 | $120.23 | $199.53 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $489.78 / $776.25
| Facility | | $416.87 | $489.78 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $194.98 / $562.34
| Professional | | $77.62 | $194.98 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $309.03 / $3,801.89
| Facility | | $64.57 | $309.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $436.52
| Professional | | $117.49 | $186.21 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $660.69
| Professional | 50 | $177.83 | $275.42 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $323.59 / $1,778.28
| Facility | | $66.07 | $323.59 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $186.21 / $575.44
| Facility | 50 | $102.33 | $186.21 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $758.58
| Professional | | $117.49 | $213.80 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $128.82
| Professional | | $32.36 | $33.11 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $891.25 / $2,344.23
| Facility | | $112.20 | $891.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $512.86
| Professional | | $125.89 | $229.09 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $213.80 / $549.54
| Professional | | $97.72 | $213.80 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,288.25 / $1,288.25
| Facility | | $181.97 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $436.52 / $1,122.02
| Professional | | $83.18 | $436.52 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $389.05
| Professional | | $134.90 | $134.90 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $331.13 / $933.25
| Professional | | $141.25 | $331.13 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $2,187.76
| Facility | | $977.24 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $165.96 / $501.19
| Professional | | $67.61 | $165.96 | $501.19 |