- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $6,918.31 / $15,848.93
| Facility | | $537.03 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $15,488.17
| Facility | 50 | $12,022.64 | $12,022.64 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $741.31 / $1,230.27
| Professional | | $549.54 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $9,549.93 / $24,547.09
| Facility | | $4,570.88 | $9,549.93 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $8,128.31 / $12,882.50 / $37,153.52
| Facility | 50 | $8,128.31 | $12,882.50 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,513.56 / $2,630.27
| Professional | | $977.24 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,754.23 / $6,456.54
| Facility | | $1,949.84 | $2,754.23 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,041.74 / $3,235.94
| Professional | | $1,258.93 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,630.27 / $5,128.61
| Facility | | $2,089.30 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,819.70 / $2,951.21
| Professional | | $1,230.27 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,698.24 / $11,481.54
| Facility | | $758.58 | $1,698.24 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | 50 | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,621.81 / $5,011.87
| Professional | | $870.96 | $1,621.81 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $9,120.11 / $12,882.50
| Facility | | $6,165.95 | $9,120.11 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,445.44 / $2,630.27
| Professional | | $758.58 | $1,445.44 | $2,630.27 |