- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $3,715.35 / $10,964.78
| Facility | | $630.96 | $3,715.35 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,677.35 / $10,715.19 / $10,964.78
| Facility | 50 | $4,677.35 | $10,715.19 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $724.44 / $2,137.96
| Professional | | $436.52 | $724.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $724.44
| Professional | | $223.87 | $416.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,511.89 / $6,025.60 / $16,218.10
| Facility | | $2,511.89 | $6,025.60 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $616.60 / $954.99
| Professional | | $501.19 | $616.60 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $758.58
| Professional | | $489.78 | $575.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $9,772.37 / $14,791.08
| Facility | | $6,456.54 | $9,772.37 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,096.48
| Professional | | $426.58 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $891.25 / $8,511.38
| Facility | | $478.63 | $891.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $707.95 / $3,801.89
| Professional | | $478.63 | $707.95 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,019.95 / $6,760.83
| Facility | | $1,288.25 | $3,019.95 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $588.84 / $954.99
| Professional | | $446.68 | $588.84 | $954.99 |