- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $6,165.95 / $11,481.54
| Facility | | $691.83 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | 50 | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $691.83 / $2,754.23
| Professional | | $302.00 | $691.83 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $1,202.26 / $2,691.53
| Professional | 50 | $302.00 | $1,202.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,220.18 / $14,454.40 / $28,183.83
| Facility | | $11,220.18 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $758.58 / $3,630.78
| Professional | | $331.13 | $758.58 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,737.80 / $5,888.44
| Professional | | $489.78 | $1,737.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,630.27 / $6,760.83
| Facility | | $446.68 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $3,467.37 / $14,454.40
| Professional | | $1,995.26 | $3,467.37 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $3,630.78 / $5,370.32
| Professional | | $794.33 | $3,630.78 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,096.48 / $6,165.95
| Professional | | $741.31 | $1,096.48 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $7,244.36 / $9,332.54
| Facility | | $4,570.88 | $7,244.36 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,905.46 / $4,466.84
| Professional | | $446.68 | $1,905.46 | $4,466.84 |