- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,090.30 / $5,128.61
| Facility | | $1,737.80 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $4,168.69
| Facility | 50 | $1,348.96 | $1,348.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,698.24 / $3,981.07
| Professional | | $154.88 | $1,698.24 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $389.05 / $6,025.60 / $7,762.47
| Professional | 50 | $389.05 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $4,265.80 / $15,135.61
| Facility | | $56.23 | $4,265.80 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $1,348.96 / $4,786.30
| Professional | | $169.82 | $1,348.96 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $426.58
| Facility | | $181.97 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $3,388.44
| Professional | | $309.03 | $309.03 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 80
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | 80 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $588.84 / $5,128.61
| Professional | | $208.93 | $588.84 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $194.98 / $3,630.78
| Facility | | $138.04 | $194.98 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,290.87 / $3,162.28
| Professional | | $1,819.70 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $5,248.07 / $11,220.18
| Facility | | $2,398.83 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,621.81 / $4,073.80
| Professional | | $162.18 | $1,621.81 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $4,265.80 / $15,135.61
| Facility | | $56.23 | $4,265.80 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $1,348.96 / $4,786.30
| Professional | | $169.82 | $1,348.96 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $5,248.07 / $12,882.50
| Facility | | $2,238.72 | $5,248.07 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,905.46 / $4,365.16
| Professional | | $194.98 | $1,905.46 | $4,365.16 |