- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,819.70 / $7,943.28
| Facility | | $234.42 | $1,819.70 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $389.05 / $1,096.48
| Professional | | $112.20 | $389.05 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Professional | 50 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $446.68 / $1,412.54
| Professional | | $147.91 | $446.68 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $263.03 / $1,258.93
| Professional | | $181.97 | $263.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $501.19 / $1,318.26
| Facility | | $131.83 | $501.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $588.84 / $1,318.26
| Professional | | $165.96 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Professional | 50 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,000.00 / $1,071.52
| Facility | | $549.54 | $1,000.00 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $467.74 / $1,230.27
| Facility | | $128.82 | $467.74 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $302.00 / $1,412.54
| Professional | | $79.43 | $302.00 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $691.83 / $1,445.44
| Professional | | $204.17 | $691.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $4,073.80 / $6,165.95
| Facility | | $389.05 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $446.68 / $1,288.25
| Professional | | $138.04 | $446.68 | $1,288.25 |