- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $3,019.95 / $22,387.21
| Facility | | $562.34 | $3,019.95 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,019.95 / $4,786.30 / $33,113.11
| Facility | 50 | $3,019.95 | $4,786.30 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $616.60 / $2,454.71
| Professional | | $263.03 | $616.60 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $338.84 / $707.95 / $4,570.88
| Professional | 50 | $338.84 | $707.95 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $257.04 / $1,548.82
| Professional | | $125.89 | $257.04 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $204.17 / $933.25 / $4,570.88
| Professional | 50 | $204.17 | $933.25 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $4,897.79 / $11,748.98
| Facility | | $2,238.72 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $707.95 / $2,290.87
| Professional | | $346.74 | $707.95 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $1,071.52 / $3,467.37
| Professional | 50 | $524.81 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,318.26 / $1,995.26
| Professional | | $275.42 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,511.38 / $17,378.01 / $29,512.09
| Facility | | $8,511.38 | $17,378.01 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $812.83 / $2,951.21
| Professional | | $331.13 | $812.83 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,122.02 / $3,630.78
| Facility | | $331.13 | $1,122.02 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $3,090.30 / $11,748.98
| Professional | | $1,479.11 | $3,090.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $707.95 / $2,630.27
| Facility | | $338.84 | $707.95 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,174.90 / $2,754.23
| Professional | | $316.23 | $1,174.90 | $2,754.23 |