- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $5,370.32 / $8,511.38
| Facility | | $1,023.29 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $1,071.52
| Professional | | $457.09 | $588.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $645.65 / $1,479.11 / $3,235.94
| Professional | 50 | $645.65 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $602.56 / $1,071.52
| Professional | | $588.84 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $870.96 / $912.01 / $1,584.89
| Professional | 50 | $870.96 | $912.01 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $602.56 / $977.24
| Professional | | $416.87 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $1,023.29
| Professional | | $741.31 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $1,023.29
| Professional | | $501.19 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $5,011.87 / $5,128.61
| Facility | | $3,715.35 | $5,011.87 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,235.94 / $3,630.78 / $4,897.79
| Facility | 50 | $3,235.94 | $3,630.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $588.84 / $724.44
| Professional | | $575.44 | $588.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $812.83 / $870.96 / $1,202.26
| Professional | 50 | $812.83 | $870.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $4,168.69 / $8,317.64
| Facility | | $831.76 | $4,168.69 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $588.84 / $1,148.15
| Professional | | $446.68 | $588.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $831.76 / $1,412.54
| Professional | | $776.25 | $831.76 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $630.96
| Facility | | $457.09 | $588.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $575.44 / $616.60
| Professional | | $457.09 | $575.44 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $3,890.45 / $7,585.78
| Facility | | $1,659.59 | $3,890.45 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $1,000.00
| Professional | | $426.58 | $602.56 | $1,000.00 |