- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $3,162.28 / $9,549.93
| Facility | | $309.03 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | 50 | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $446.68 / $3,162.28
| Professional | | $177.83 | $446.68 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $165.96 / $4,073.80 / $6,165.95
| Professional | 50 | $165.96 | $4,073.80 | $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
- $190.55 / $891.25 / $3,715.35
| Professional | | $190.55 | $891.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $1,348.96 / $5,495.41
| Professional | 50 | $288.40 | $1,348.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $1,584.89 / $2,570.40
| Professional | | $158.49 | $1,584.89 | $2,570.40 |
- 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
- $199.53 / $426.58 / $4,168.69
| Professional | | $199.53 | $426.58 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $2,630.27 / $5,888.44
| Facility | | $218.78 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,630.78 / $19,054.61
| Professional | | $1,905.46 | $3,630.78 | $19,054.61 |
- 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
- $208.93 / $1,548.82 / $3,890.45
| Professional | | $208.93 | $1,548.82 | $3,890.45 |