- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $3,981.07 / $6,918.31
| Facility | | $1,348.96 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 50 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $2,754.23 / $5,754.40
| Professional | | $263.03 | $2,754.23 | $5,754.40 |
- 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
- $302.00 / $3,162.28 / $5,623.41
| Professional | | $302.00 | $3,162.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,073.80 / $4,786.30 / $5,248.07
| Professional | 50 | $4,073.80 | $4,786.30 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- AS
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $489.78
| Professional | AS | $380.19 | $446.68 | $489.78 |
- 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
- $263.03 / $3,388.44 / $5,370.32
| Professional | | $263.03 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $380.19 / $4,786.30
| Professional | | $6.31 | $380.19 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $316.23 / $4,466.84
| Professional | | $5.37 | $316.23 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,951.21 / $2,951.21
| Professional | | $213.80 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,090.30 / $9,332.54
| Facility | | $1,659.59 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $2,951.21 / $5,888.44
| Professional | | $245.47 | $2,951.21 | $5,888.44 |