- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $5,011.87 / $7,943.28
| Facility | | $977.24 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $2,570.40
| Professional | | $549.54 | $758.58 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $8,511.38 / $17,378.01
| Facility | | $3,890.45 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $9,120.11 / $14,454.40 / $40,738.03
| Facility | 50 | $9,120.11 | $14,454.40 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,584.89 / $2,454.71
| Professional | | $1,047.13 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,290.87 / $5,495.41
| Facility | | $1,621.81 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,995.26 / $2,951.21
| Professional | | $1,258.93 | $1,995.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,238.72 / $4,365.16
| Facility | | $1,778.28 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,659.59 / $2,511.89
| Professional | | $1,096.48 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,884.03 / $7,762.47
| Facility | | $870.96 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,445.44 / $3,388.44
| Professional | | $741.31 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $10,000.00
| Facility | | $3,019.95 | $5,248.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,412.54 / $2,570.40
| Professional | | $676.08 | $1,412.54 | $2,570.40 |