- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,344.23 / $7,585.78
| Facility | | $575.44 | $2,344.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $10,964.78
| Facility | 50 | $2,398.83 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $977.24 / $2,570.40
| Professional | | $549.54 | $977.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $741.31 / $1,318.26
| Professional | | $512.86 | $741.31 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,801.89 / $7,585.78
| Facility | | $3,019.95 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $933.25 / $1,318.26
| Professional | | $562.34 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,380.38 / $1,778.28
| Professional | | $602.56 | $1,380.38 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,047.13 / $5,248.07
| Facility | | $549.54 | $1,047.13 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $5,754.40
| Facility | 50 | $4,168.69 | $4,168.69 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $158.49 / $501.19 / $501.19
| Facility | AS | $158.49 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,071.52 / $5,888.44
| Professional | | $616.60 | $1,071.52 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,348.96 / $1,862.09
| Professional | | $1,174.90 | $1,348.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,348.96 / $1,862.09
| Professional | | $1,174.90 | $1,348.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Facility | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,023.29 / $1,348.96
| Professional | | $575.44 | $1,023.29 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,630.78 / $6,760.83
| Facility | | $2,398.83 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,071.52 / $1,584.89
| Professional | | $660.69 | $1,071.52 | $1,584.89 |