- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $3,162.28 / $7,079.46
| Facility | | $741.31 | $3,162.28 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $776.25 / $3,388.44 / $7,079.46
| Facility | 50 | $776.25 | $3,388.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $776.25 / $2,884.03
| Professional | | $288.40 | $776.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $489.78 / $1,659.59 / $5,011.87
| Professional | 50 | $489.78 | $1,659.59 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $1,548.82
| Professional | | $194.98 | $281.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $354.81 / $1,047.13 / $4,570.88
| Professional | 50 | $354.81 | $1,047.13 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $831.76 / $3,548.13
| Professional | | $407.38 | $831.76 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $1,258.93 / $5,370.32
| Professional | 50 | $602.56 | $1,258.93 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $416.87 / $562.34
| Facility | | $354.81 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,445.44 / $1,862.09
| Professional | | $1,202.26 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $3,388.44
| Professional | | $363.08 | $851.14 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,513.56 / $2,951.21
| Professional | | $295.12 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $1,288.25 / $2,818.38
| Professional | | $288.40 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,348.96 / $2,344.23
| Facility | | $354.81 | $1,348.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,202.26 / $3,162.28
| Professional | | $316.23 | $1,202.26 | $3,162.28 |