- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $9,120.11 / $18,197.01
| Facility | | $891.25 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $6,606.93 / $7,079.46 / $13,803.84
| Facility | 50 | $6,606.93 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $794.33 / $1,548.82
| Professional | | $588.84 | $794.33 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $537.03 / $1,445.44 / $4,365.16
| Professional | 50 | $537.03 | $1,445.44 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $4,897.79 / $9,332.54
| Facility | | $1,949.84 | $4,897.79 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $870.96 / $1,479.11
| Professional | | $616.60 | $870.96 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $2,511.89
| Facility | | $707.95 | $707.95 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,659.59
| Professional | | $741.31 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,000.00 / $1,905.46
| Facility | | $707.95 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $10,232.93 / $16,982.44
| Facility | | $2,884.03 | $10,232.93 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,479.11
| Professional | | $645.65 | $870.96 | $1,479.11 |