- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,691.53 / $8,912.51
| Facility | | $776.25 | $2,691.53 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $758.58 / $1,479.11
| Professional | | $562.34 | $758.58 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,148.15 / $2,137.96 / $2,398.83
| Professional | 50 | $1,148.15 | $2,137.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $691.83 / $1,288.25 / $1,288.25
| Professional | 54 | $691.83 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $4,168.69 / $10,000.00
| Facility | | $1,548.82 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $741.31 / $1,445.44
| Professional | | $524.81 | $741.31 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $2,041.74
| Professional | 50 | $776.25 | $1,096.48 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,513.56 / $5,128.61
| Facility | | $478.63 | $1,513.56 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Facility | 54 | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $1,949.84
| Professional | | $537.03 | $870.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,511.89 / $5,888.44
| Facility | | $794.33 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $707.95 / $1,445.44
| Professional | | $501.19 | $707.95 | $1,445.44 |