- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $5,370.32 / $8,511.38
| Facility | | $812.83 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $794.33 / $2,754.23
| Professional | | $309.03 | $794.33 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $5,623.41 / $12,589.25
| Facility | | $2,754.23 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $11,481.54 / $22,387.21
| Facility | 50 | $4,168.69 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,380.38 / $1,995.26
| Professional | | $891.25 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,995.26 / $4,677.35
| Facility | | $1,479.11 | $1,995.26 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,621.81 / $2,398.83
| Professional | | $954.99 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,905.46 / $3,715.35
| Facility | | $1,548.82 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,348.96 / $2,137.96
| Professional | | $954.99 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $2,570.40 / $6,456.54
| Facility | | $741.31 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $6,456.54
| Facility | 50 | $3,715.35 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $812.83
| Facility | AS | $141.25 | $141.25 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,348.96 / $3,235.94
| Professional | | $602.56 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $6,025.60 / $10,715.19
| Facility | | $3,162.28 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,148.15 / $2,187.76
| Professional | | $562.34 | $1,148.15 | $2,187.76 |