- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $4,466.84 / $7,943.28
| Facility | | $2,089.30 | $4,466.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,659.59 / $5,888.44 / $13,489.63
| Facility | 50 | $1,659.59 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $588.84 / $2,454.71
| Professional | | $389.05 | $588.84 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,047.13 / $1,412.54 / $5,888.44
| Professional | 50 | $1,047.13 | $1,412.54 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $6,456.54 / $12,302.69
| Facility | | $2,754.23 | $6,456.54 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,288.25
| Professional | | $398.11 | $676.08 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $630.96 / $1,584.89
| Professional | | $398.11 | $630.96 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $831.76
| Professional | | $407.38 | $602.56 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,981.07 / $6,309.57 / $10,000.00
| Facility | | $3,981.07 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $501.19 / $2,089.30
| Professional | | $363.08 | $501.19 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $6,165.95 / $10,471.29
| Facility | | $2,884.03 | $6,165.95 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $1,122.02
| Professional | | $288.40 | $512.86 | $1,122.02 |