- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,090.30 / $8,912.51
| Facility | | $549.54 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $575.44
| Facility | 50 | $524.81 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $85.11 / $181.97
| Professional | | $43.65 | $85.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $588.84
| Professional | 50 | $234.42 | $338.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $4,168.69 / $12,302.69
| Facility | | $70.79 | $4,168.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $81.28 / $114.82
| Professional | | $41.69 | $81.28 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $53.70 / $323.59
| Facility | | $50.12 | $53.70 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $97.72 / $181.97
| Professional | | $48.98 | $97.72 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,466.84
| Facility | | $1,698.24 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $154.88
| Professional | | $54.95 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $109.65
| Professional | | $32.36 | $39.81 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,445.44 / $3,630.78
| Facility | | $263.03 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $151.36
| Professional | | $42.66 | $79.43 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $83.18
| Professional | | $39.81 | $61.66 | $83.18 |