- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $3,801.89 / $6,760.83
| Facility | | $263.03 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $1,071.52 / $4,168.69
| Professional | | $162.18 | $1,071.52 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $194.98 / $691.83 / $3,162.28
| Professional | 50 | $194.98 | $691.83 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $512.86 / $4,897.79
| Professional | | $407.38 | $512.86 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $2,344.23 / $7,413.10
| Professional | | $165.96 | $2,344.23 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $4,897.79 / $16,982.44
| Facility | | $436.52 | $4,897.79 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $4,073.80 / $10,964.78
| Professional | | $467.74 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $3,801.89 / $5,370.32
| Professional | | $416.87 | $3,801.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $616.60 / $5,128.61
| Professional | | $398.11 | $616.60 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $4,677.35 / $5,370.32
| Professional | | $5.01 | $4,677.35 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $10,232.93 / $18,620.87
| Facility | | $5,495.41 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,737.80 / $5,623.41
| Professional | | $204.17 | $1,737.80 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $3,467.37
| Professional | | $331.13 | $389.05 | $3,467.37 |