- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $512.86 / $2,884.03
| Facility | | $151.36 | $512.86 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $660.69 / $1,479.11
| Facility | 50 | $616.60 | $660.69 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $346.74
| Professional | | $69.18 | $125.89 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $208.93 / $724.44
| Professional | 50 | $158.49 | $208.93 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $123.03
| Professional | | $77.62 | $112.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $165.96
| Professional | 50 | $138.04 | $138.04 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $204.17
| Professional | | $134.90 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $269.15
| Professional | 50 | $218.78 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $87.10 / $114.82
| Facility | | $85.11 | $87.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $117.49 / $331.13
| Professional | | $72.44 | $117.49 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $602.56 / $4,897.79
| Facility | | $154.88 | $602.56 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $1,479.11
| Facility | 50 | $616.60 | $645.65 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $281.84
| Professional | | $91.20 | $131.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $660.69
| Professional | 50 | $131.83 | $208.93 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $104.71 / $181.97
| Professional | | $53.70 | $104.71 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $851.14 / $1,698.24
| Facility | | $263.03 | $851.14 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $239.88
| Professional | | $100.00 | $131.83 | $239.88 |