- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $1,258.93 / $9,772.37
| Facility | | $61.66 | $1,258.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $295.12
| Professional | | $57.54 | $104.71 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | 50 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,862.09 / $4,168.69
| Facility | | $933.25 | $1,862.09 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,621.81 / $2,630.27 / $7,413.10
| Facility | 50 | $1,621.81 | $2,630.27 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $218.78 / $416.87
| Professional | | $114.82 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $630.96
| Professional | 50 | $173.78 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $436.52 / $1,047.13
| Facility | | $309.03 | $436.52 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $263.03 / $489.78
| Professional | | $138.04 | $263.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $812.83
| Facility | | $331.13 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $426.58
| Professional | | $134.90 | $245.47 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $263.03 / $2,884.03
| Facility | | $91.20 | $263.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | 50 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $204.17 / $912.01
| Professional | | $93.33 | $204.17 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | 50 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,238.72 / $5,370.32
| Facility | | $1,174.90 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $151.36 / $331.13
| Professional | | $74.13 | $151.36 | $331.13 |