- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $831.76 / $2,187.76
| Professional | | $269.15 | $831.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | 50 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $6,025.60 / $9,549.93
| Facility | | $1,995.26 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,951.21 / $9,120.11 / $12,589.25
| Facility | 50 | $2,951.21 | $9,120.11 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,778.28 / $2,344.23
| Professional | | $467.74 | $1,778.28 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $691.83 / $812.83 / $3,388.44
| Professional | 50 | $691.83 | $812.83 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,202.26 / $2,344.23
| Professional | | $338.84 | $1,202.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,905.46 / $1,905.46
| Professional | | $1,862.09 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,230.27 / $2,818.38
| Facility | | $309.03 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,230.27 / $2,818.38
| Professional | | $416.87 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $478.63 / $758.58
| Professional | | $32.36 | $478.63 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,754.40 / $7,244.36 / $10,471.29
| Facility | | $5,754.40 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $8,709.64 / $12,022.64 / $15,488.17
| Facility | 50 | $8,709.64 | $12,022.64 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $2,511.89
| Professional | | $512.86 | $691.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,148.15 / $6,025.60
| Professional | | $512.86 | $1,148.15 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,023.29 / $2,454.71
| Professional | | $309.03 | $1,023.29 | $2,454.71 |