- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $2,238.72 / $5,623.41
| Facility | | $151.36 | $2,238.72 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $154.88 / $323.59
| Professional | | $67.61 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $436.52
| Professional | 50 | $245.47 | $338.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $104.71
| Professional | | $61.66 | $61.66 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $147.91 / $257.04
| Professional | | $75.86 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $389.05
| Professional | 50 | $112.20 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $169.82 / $229.09
| Professional | | $66.07 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $181.97 / $363.08
| Professional | | $83.18 | $181.97 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $223.87 / $2,630.27
| Facility | | $54.95 | $223.87 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $1,318.26
| Professional | | $162.18 | $245.47 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,778.28 / $2,884.03
| Facility | | $1,071.52 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $288.40
| Professional | | $77.62 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | 50 | $79.43 | $79.43 | $79.43 |