- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $724.44 / $2,951.21
| Facility | | $151.36 | $724.44 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $537.03 / $1,621.81
| Professional | | $144.54 | $537.03 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $3,019.95 / $7,079.46
| Facility | | $1,479.11 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,630.78 / $6,025.60 / $16,595.87
| Facility | 50 | $3,630.78 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $776.25 / $2,238.72
| Professional | | $263.03 | $776.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,511.89 / $5,888.44
| Facility | | $1,778.28 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,000.00 / $2,754.23
| Professional | | $338.84 | $1,000.00 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,344.23 / $4,570.88
| Facility | | $1,862.09 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $977.24 / $2,290.87
| Professional | | $316.23 | $977.24 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,023.29 / $3,981.07
| Facility | | $194.98 | $1,023.29 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,380.38 / $3,388.44
| Professional | | $691.83 | $1,380.38 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $3,235.94 / $5,623.41
| Facility | | $1,584.89 | $3,235.94 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $676.08 / $2,187.76
| Professional | | $229.09 | $676.08 | $2,187.76 |