- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $5,623.41 / $8,912.51
| Facility | | $562.34 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $831.76 / $2,630.27
| Professional | | $549.54 | $831.76 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $5,623.41 / $12,589.25
| Facility | | $2,754.23 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $11,481.54 / $22,387.21
| Facility | 50 | $4,168.69 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,445.44 / $2,089.30
| Professional | | $933.25 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $4,897.79
| Facility | | $1,548.82 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,659.59 / $2,511.89
| Professional | | $1,000.00 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,995.26 / $3,890.45
| Facility | | $1,584.89 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,412.54 / $2,238.72
| Professional | | $977.24 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,513.56 / $6,606.93
| Facility | | $616.60 | $1,513.56 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,174.90 / $4,677.35
| Professional | | $602.56 | $1,174.90 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $6,025.60 / $10,715.19
| Facility | | $3,162.28 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,174.90 / $2,290.87
| Professional | | $588.84 | $1,174.90 | $2,290.87 |