- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,090.30 / $5,128.61
| Facility | | $1,778.28 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $32,359.37 / $32,359.37 / $32,359.37
| Facility | 50 | $32,359.37 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $2,630.27 / $5,888.44
| Professional | | $436.52 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,128.61 / $26,302.68
| Facility | | $56.23 | $5,128.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,187.76 / $8,128.31
| Professional | | $446.68 | $2,187.76 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $1,122.02
| Facility | | $478.63 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $2,818.38 / $6,025.60
| Professional | | $478.63 | $2,818.38 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,951.21 / $7,943.28
| Professional | | $588.84 | $2,951.21 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $562.34 / $3,630.78
| Facility | | $426.58 | $562.34 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,801.89 / $5,495.41
| Professional | | $3,090.30 | $3,801.89 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $6,918.31 / $20,417.38
| Facility | | $3,467.37 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,691.53 / $6,760.83
| Professional | | $467.74 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $12,022.64
| Facility | | $4,073.80 | $4,073.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,128.61 / $26,302.68
| Facility | | $56.23 | $5,128.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,187.76 / $8,128.31
| Professional | | $446.68 | $2,187.76 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $6,918.31 / $30,199.52
| Facility | | $3,235.94 | $6,918.31 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $3,162.28 / $7,762.47
| Professional | | $537.03 | $3,162.28 | $7,762.47 |