- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $6,456.54 / $7,079.46
| Facility | | $2,511.89 | $6,456.54 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,128.61 / $6,025.60 / $6,309.57
| Facility | 50 | $5,128.61 | $6,025.60 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $933.25
| Professional | | $194.98 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $2,951.21
| Professional | 50 | $436.52 | $630.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $562.34 / $1,318.26
| Professional | | $190.55 | $562.34 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $933.25 / $5,370.32
| Facility | | $218.78 | $933.25 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,630.78 / $5,370.32 / $6,309.57
| Facility | 50 | $3,630.78 | $5,370.32 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $851.14 / $2,041.74
| Professional | | $389.05 | $851.14 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $436.52 / $812.83 / $7,943.28
| Professional | 50 | $436.52 | $812.83 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,548.82 / $2,344.23
| Professional | | $776.25 | $1,548.82 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $630.96 / $1,995.26
| Facility | | $213.80 | $630.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $389.05 / $1,000.00
| Professional | | $60.26 | $389.05 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $3,981.07
| Facility | | $1,548.82 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $660.69 / $2,089.30
| Professional | | $213.80 | $660.69 | $2,089.30 |