- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $4,073.80 / $9,332.54
| Facility | | $870.96 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $0.56 / $0.56 / $4,677.35
| Facility | 50 | $0.56 | $0.56 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $954.99 / $2,041.74
| Professional | | $275.42 | $954.99 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $229.09
| Professional | 50 | $162.18 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $323.59
| Professional | | $125.89 | $239.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,311.31 / $12,302.69
| Facility | | $891.25 | $3,311.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,047.13 / $1,380.38
| Professional | | $288.40 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $3,548.13
| Facility | | $323.59 | $478.63 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $954.99 / $2,398.83
| Professional | | $316.23 | $954.99 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $9,120.11 / $16,982.44
| Facility | | $4,570.88 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $977.24 / $1,737.80
| Professional | | $870.96 | $977.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $213.80 / $1,621.81
| Professional | | $32.36 | $213.80 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $6,760.83 / $12,022.64
| Facility | | $1,995.26 | $6,760.83 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $954.99 / $2,290.87
| Professional | | $275.42 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $912.01 / $1,230.27
| Professional | | $213.80 | $912.01 | $1,230.27 |