- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $3,548.13 / $3,548.13
| Facility | | $263.03 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $2,818.38 / $5,011.87
| Professional | | $251.19 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $12,882.50 / $31,622.78
| Facility | | $1,778.28 | $12,882.50 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $16,218.10 / $26,302.68 / $74,131.02
| Facility | 50 | $16,218.10 | $26,302.68 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,621.81 / $10,471.29
| Professional | | $457.09 | $1,621.81 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $2,398.83 / $15,848.93
| Professional | 50 | $691.83 | $2,398.83 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $12,022.64 / $28,183.83
| Facility | | $7,413.10 | $12,022.64 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $4,570.88 / $12,882.50
| Professional | | $549.54 | $4,570.88 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $10,471.29 / $21,379.62
| Facility | | $8,709.64 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $4,265.80 / $11,481.54
| Professional | | $549.54 | $4,265.80 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $4,265.80 / $9,332.54
| Facility | | $338.84 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $7,943.28 / $19,952.62
| Professional | | $4,365.16 | $7,943.28 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $6,760.83 / $18,197.01
| Facility | | $1,584.89 | $6,760.83 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $3,467.37 / $11,748.98
| Professional | | $363.08 | $3,467.37 | $11,748.98 |