- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,471.29 / $20,417.38
| Facility | | $3,801.89 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $12,302.69 / $16,595.87 / $16,595.87
| Facility | 50 | $12,302.69 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,513.56 / $4,073.80
| Professional | | $302.00 | $1,513.56 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $154.88 / $380.19 / $1,288.25
| Professional | AS | $154.88 | $380.19 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,884.03 / $3,630.78
| Professional | | $1,995.26 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,819.70 / $6,025.60
| Professional | | $1,202.26 | $1,819.70 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,801.89 / $32,359.37
| Facility | | $1,995.26 | $3,801.89 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Typical Low / Median / Typical High
- $34,673.69 / $34,673.69 / $34,673.69
| Facility | 54 | $34,673.69 | $34,673.69 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | AS | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,754.23 / $11,220.18
| Professional | | $1,412.54 | $2,754.23 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,090.30 / $3,715.35
| Professional | | $2,818.38 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $3,467.37
| Professional | | $2,691.53 | $2,691.53 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,137.96 / $2,818.38
| Professional | | $1,202.26 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,471.29 / $17,378.01 / $33,884.42
| Facility | | $10,471.29 | $17,378.01 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,137.96 / $4,466.84
| Professional | | $1,348.96 | $2,137.96 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,511.89 / $2,951.21
| Professional | | $1,949.84 | $2,511.89 | $2,951.21 |