- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $1,659.59 / $6,456.54
| Facility | | $93.33 | $1,659.59 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 50 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $56.23 / $123.03
| Professional | | $30.20 | $56.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $33.11 / $69.18
| Professional | | $14.79 | $33.11 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $4,466.84 / $4,786.30
| Facility | | $912.01 | $4,466.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $151.36
| Professional | | $61.66 | $61.66 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $138.04
| Professional | | $37.15 | $58.88 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $79.43 / $741.31
| Facility | | $37.15 | $79.43 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $85.11 / $1,659.59
| Professional | | $41.69 | $85.11 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $407.38 / $1,905.46
| Facility | | $165.96 | $407.38 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $123.03
| Professional | | $34.67 | $52.48 | $123.03 |