- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,659.59 / $4,365.16
| Facility | | $436.52 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,786.30 / $10,715.19 / $17,782.79
| Facility | 50 | $4,786.30 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $776.25 / $2,454.71
| Professional | | $309.03 | $776.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $3,630.78
| Professional | 50 | $363.08 | $707.95 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $158.49 / $239.88
| Professional | | $144.54 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $251.19 / $707.95
| Professional | 50 | $239.88 | $251.19 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $8,317.64 / $12,022.64
| Facility | | $4,570.88 | $8,317.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $707.95 / $2,818.38
| Professional | | $457.09 | $707.95 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $5,495.41 / $5,495.41
| Facility | | $39.81 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $891.25 / $2,691.53
| Professional | | $363.08 | $891.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $6,760.83 / $12,882.50
| Facility | | $1,288.25 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,318.26 / $2,691.53
| Professional | | $316.23 | $1,318.26 | $2,691.53 |