- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,511.89 / $8,511.38
| Facility | | $512.86 | $2,511.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 50 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $724.44 / $6,165.95
| Professional | | $309.03 | $724.44 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $9,549.93
| Professional | 50 | $676.08 | $676.08 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $3,019.95 / $9,772.37
| Professional | | $275.42 | $3,019.95 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $8,128.31 / $13,489.63
| Facility | | $2,238.72 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,023.29 / $8,317.64
| Professional | | $371.54 | $1,023.29 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $933.25 / $6,606.93
| Professional | | $371.54 | $933.25 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $42,657.95 / $42,657.95
| Facility | | $54.95 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23,442.29 / $27,542.29 / $27,542.29
| Professional | | $23,442.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $11,481.54 / $19,952.62
| Facility | | $6,456.54 | $11,481.54 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $2,951.21 / $6,606.93
| Professional | | $338.84 | $2,951.21 | $6,606.93 |