- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,122.02 / $3,801.89
| Facility | | $218.78 | $1,122.02 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,513.56
| Facility | 50 | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $295.12 / $1,122.02
| Professional | | $100.00 | $295.12 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $912.01
| Professional | | $245.47 | $338.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $363.08 / $954.99
| Professional | | $107.15 | $363.08 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $776.25 / $3,235.94
| Facility | | $263.03 | $776.25 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 52 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Facility | 53 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $691.83 / $1,862.09
| Professional | | $288.40 | $691.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $676.08 / $851.14
| Professional | | $263.03 | $676.08 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $331.13 / $1,258.93
| Professional | | $213.80 | $331.13 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $870.96 / $1,548.82
| Professional | | $3.98 | $870.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,778.28 / $5,128.61
| Facility | | $912.01 | $1,778.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $331.13 / $954.99
| Professional | | $131.83 | $331.13 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $234.42 / $660.69
| Professional | | $199.53 | $234.42 | $660.69 |