- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $2,570.40 / $10,715.19
| Facility | | $154.88 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,023.29 / $6,456.54 / $6,456.54
| Facility | 50 | $1,023.29 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $407.38
| Professional | | $100.00 | $158.49 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $645.65 / $758.58
| Professional | 50 | $151.36 | $645.65 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $316.23
| Professional | 50 | $190.55 | $190.55 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $204.17
| Professional | | $95.50 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $302.00
| Professional | 50 | $141.25 | $190.55 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $123.03
| Facility | | $104.71 | $104.71 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $21,379.62
| Facility | | $173.78 | $173.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $316.23
| Professional | | $114.82 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,778.28 / $21,379.62
| Facility | | $794.33 | $1,778.28 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $302.00
| Professional | | $114.82 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Professional | 50 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $81.28
| Professional | | $32.36 | $33.11 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $436.52
| Facility | | $100.00 | $100.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $281.84
| Professional | | $95.50 | $158.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,737.80 / $4,073.80
| Facility | | $537.03 | $1,737.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $269.15
| Professional | | $95.50 | $158.49 | $269.15 |