- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $4,677.35 / $7,413.10
| Facility | | $1,778.28 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | 50 | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $389.05 / $741.31
| Professional | | $281.84 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $389.05 / $562.34
| Professional | | $288.40 | $389.05 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,818.38 / $5,888.44
| Facility | | $1,148.15 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $588.84
| Professional | | $295.12 | $467.74 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,244.36 / $9,772.37
| Facility | | $5,011.87 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $467.74 / $758.58
| Professional | | $281.84 | $467.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $354.81 / $758.58
| Professional | | $275.42 | $354.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Professional | 22 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Professional | 52 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Professional | 53 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $575.44
| Professional | | $398.11 | $501.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $3,890.45 / $6,606.93
| Facility | | $1,202.26 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $416.87 / $724.44
| Professional | | $309.03 | $416.87 | $724.44 |