- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $3,388.44 / $12,022.64
| Facility | | $169.82 | $3,388.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $2,344.23
| Facility | 50 | $1,862.09 | $1,862.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,659.59 / $3,548.13
| Professional | | $154.88 | $1,659.59 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $831.76 / $6,025.60 / $6,165.95
| Professional | 50 | $831.76 | $6,025.60 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,479.11 / $4,168.69
| Facility | | $758.58 | $1,479.11 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $758.58 / $2,884.03
| Professional | | $165.96 | $758.58 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $245.47 / $1,122.02 / $4,265.80
| Professional | 50 | $245.47 | $1,122.02 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,513.56 / $2,511.89
| Professional | | $141.25 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $13,182.57 / $17,782.79
| Facility | | $11,481.54 | $13,182.57 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $398.11 / $3,630.78
| Professional | | $173.78 | $398.11 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,511.89 / $5,888.44
| Facility | | $190.55 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,884.03 / $12,022.64
| Professional | | $1,862.09 | $2,884.03 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,090.30 / $6,025.60
| Facility | | $2,137.96 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,513.56 / $3,019.95
| Professional | | $186.21 | $1,513.56 | $3,019.95 |