- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,168.69 / $13,182.57
| Facility | | $2,041.74 | $4,168.69 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,148.15 / $2,570.40
| Professional | | $812.83 | $1,148.15 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $6,918.31
| Professional | 50 | $1,230.27 | $1,230.27 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Facility | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,698.24 / $2,754.23
| Professional | | $1,071.52 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,949.84 / $2,238.72
| Professional | | $1,513.56 | $1,949.84 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $2,691.53
| Facility | | $1,000.00 | $1,584.89 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,659.59 / $2,691.53
| Professional | | $1,348.96 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,230.27 / $1,230.27 / $6,918.31
| Professional | 50 | $1,230.27 | $1,230.27 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,862.09 / $2,089.30
| Facility | | $1,288.25 | $1,862.09 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $2,630.27
| Facility | | $1,000.00 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $1,737.80 / $2,630.27
| Professional | | $79.43 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $12,302.69 / $15,135.61
| Facility | | $8,912.51 | $12,302.69 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $13,182.57 / $18,620.87 / $22,387.21
| Facility | 50 | $13,182.57 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,238.72 / $3,090.30
| Professional | | $1,584.89 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $13,182.57 / $25,118.86
| Facility | | $4,073.80 | $13,182.57 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,737.80 / $2,691.53
| Professional | | $1,071.52 | $1,737.80 | $2,691.53 |