- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $1,122.02 / $4,897.79
| Facility | | $75.86 | $1,122.02 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | 50 | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $436.52
| Professional | | $48.98 | $104.71 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $123.03 / $436.52
| Professional | 50 | $69.18 | $123.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $109.65
| Professional | | $38.90 | $48.98 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $3,981.07
| Facility | | $676.08 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $134.90
| Professional | | $52.48 | $74.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $204.17
| Professional | 50 | $79.43 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $107.15 / $162.18
| Professional | | $45.71 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $109.65 / $199.53
| Professional | | $56.23 | $109.65 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $131.83 / $954.99
| Facility | | $52.48 | $131.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | 53 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $190.55 / $2,511.89
| Professional | | $107.15 | $190.55 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $707.95 / $1,778.28
| Facility | | $338.84 | $707.95 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $97.72 / $190.55
| Professional | | $52.48 | $97.72 | $190.55 |