- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,818.38 / $5,888.44
| Facility | | $1,148.15 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 50 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,445.44 / $3,019.95
| Professional | | $162.18 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $389.05
| Professional | 50 | $125.89 | $125.89 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $9,549.93 / $13,489.63
| Facility | | $6,165.95 | $9,549.93 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,698.24 / $3,019.95
| Professional | | $186.21 | $1,698.24 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,137.96 / $2,511.89 / $2,818.38
| Professional | 50 | $2,137.96 | $2,511.89 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $1,819.70 / $2,818.38
| Professional | | $165.96 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $239.88 / $2,630.27
| Professional | | $3.47 | $239.88 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $199.53 / $2,344.23
| Professional | | $3.02 | $199.53 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $1,584.89 / $1,584.89
| Professional | | $131.83 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,951.21 / $9,332.54
| Facility | | $1,288.25 | $2,951.21 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $1,621.81 / $3,235.94
| Professional | | $158.49 | $1,621.81 | $3,235.94 |