- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,380.38 / $4,897.79
| Facility | | $323.59 | $1,380.38 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,778.28 / $6,456.54 / $7,079.46
| Facility | 50 | $1,778.28 | $6,456.54 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $724.44
| Professional | | $263.03 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $562.34 / $758.58 / $1,047.13
| Professional | 50 | $562.34 | $758.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $288.40 / $302.00
| Professional | | $169.82 | $288.40 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | 50 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $8,317.64 / $10,471.29
| Facility | | $3,467.37 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $630.96
| Professional | | $269.15 | $426.58 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $407.38 / $645.65 / $933.25
| Professional | 50 | $407.38 | $645.65 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $288.40 / $323.59
| Facility | | $275.42 | $288.40 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $426.58 / $776.25
| Professional | | $295.12 | $426.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $6,025.60 / $14,125.38
| Facility | | $1,318.26 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $630.96
| Professional | | $275.42 | $380.19 | $630.96 |