- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,754.23 / $11,481.54
| Facility | | $588.84 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,023.29 / $2,570.40 / $26,915.35
| Facility | 50 | $1,023.29 | $2,570.40 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $676.08 / $2,951.21
| Professional | | $281.84 | $676.08 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $371.54 / $794.33 / $4,570.88
| Professional | 50 | $371.54 | $794.33 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $416.87 / $1,380.38
| Professional | | $141.25 | $416.87 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $1,096.48
| Professional | 50 | $229.09 | $229.09 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $3,388.44 / $6,456.54
| Facility | | $1,288.25 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,380.38 / $2,041.74
| Professional | | $354.81 | $1,380.38 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $17,378.01 / $17,378.01
| Facility | | $8,511.38 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $851.14 / $2,818.38
| Professional | | $331.13 | $851.14 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,905.46 / $4,168.69
| Professional | | $407.38 | $1,905.46 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $1,778.28
| Professional | | $338.84 | $380.19 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $851.14 / $2,344.23
| Facility | | $208.93 | $851.14 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $660.69 / $2,630.27
| Professional | | $331.13 | $660.69 | $2,630.27 |