- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $2,951.21 / $5,754.40
| Facility | | $275.42 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $794.33
| Facility | 50 | $758.58 | $758.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $630.96
| Professional | | $204.17 | $295.12 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $630.96 / $977.24
| Professional | 50 | $346.74 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 54
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | 54 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,570.88 / $8,912.51
| Facility | | $2,238.72 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $524.81
| Professional | | $223.87 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $794.33
| Professional | 50 | $331.13 | $501.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $251.19 / $446.68
| Professional | | $177.83 | $251.19 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $389.05
| Facility | | $144.54 | $144.54 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $602.56
| Professional | | $199.53 | $331.13 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $478.63 / $1,819.70
| Facility | | $54.95 | $478.63 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | 54 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $371.54 / $4,466.84
| Professional | | $234.42 | $371.54 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $912.01
| Professional | 50 | $407.38 | $602.56 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,047.13 / $2,041.74
| Facility | | $436.52 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $446.68
| Professional | | $199.53 | $295.12 | $446.68 |