- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,513.56 / $4,168.69
| Facility | | $645.65 | $1,513.56 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | 50 | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $537.03 / $1,348.96
| Professional | | $245.47 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Professional | 50 | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $128.82 / $275.42
| Professional | | $120.23 | $128.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,884.03 / $6,606.93
| Facility | | $1,071.52 | $2,884.03 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $1,412.54
| Professional | | $346.74 | $645.65 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $234.42 / $234.42
| Facility | | $39.81 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $630.96 / $1,412.54
| Professional | | $281.84 | $630.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $549.54 / $1,318.26
| Facility | | $213.80 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $660.69 / $1,548.82
| Professional | | $257.04 | $660.69 | $1,548.82 |