- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $7,244.36 / $13,489.63
| Facility | | $3,235.94 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | 50 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $1,548.82 / $3,235.94
| Professional | | $144.54 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $6,606.93 / $6,606.93
| Professional | 50 | $4,786.30 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $1,318.26 / $3,162.28
| Professional | | $177.83 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,995.26 / $4,786.30
| Professional | | $338.84 | $1,995.26 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $2,630.27 / $8,709.64
| Facility | | $186.21 | $2,630.27 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,981.07 / $6,025.60
| Professional | | $2,398.83 | $3,981.07 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $3,388.44 / $5,370.32
| Professional | | $346.74 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $3,467.37
| Professional | | $346.74 | $346.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $407.38 / $5,248.07
| Professional | | $5.01 | $407.38 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $7,585.78 / $10,715.19
| Facility | | $4,677.35 | $7,585.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,238.72 / $4,168.69
| Professional | | $208.93 | $2,238.72 | $4,168.69 |