- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $14,454.40 / $26,302.68
| Facility | | $5,011.87 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $22,387.21 / $27,542.29 / $35,481.34
| Facility | 50 | $22,387.21 | $27,542.29 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,148.15 / $1,513.56
| Facility | | $1,047.13 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $2,691.53 / $4,466.84
| Facility | | $2,290.87 | $2,691.53 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,995.26 / $7,244.36
| Facility | | $870.96 | $1,995.26 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $3,162.28 / $16,595.87
| Facility | | $891.25 | $3,162.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $10,715.19 / $17,378.01
| Facility | | $1,862.09 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,137.96 / $3,162.28
| Professional | | $1,412.54 | $2,137.96 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7,244.36 / $13,489.63 / $19,952.62
| Facility | | $7,244.36 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,995.26
| Facility | AS | $1,348.96 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $14,125.38 / $17,782.79
| Facility | | $8,912.51 | $14,125.38 | $17,782.79 |