- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,621.81 / $1,621.81
| Facility | | $154.88 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $1,548.82 / $2,511.89
| Professional | | $154.88 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,570.88 / $13,182.57
| Facility | | $2,454.71 | $4,570.88 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,096.48 / $4,168.69
| Professional | | $257.04 | $1,096.48 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $380.19 / $1,659.59 / $6,456.54
| Professional | 50 | $380.19 | $1,659.59 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $5,128.61 / $12,302.69
| Facility | | $3,548.13 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,071.52 / $5,623.41
| Professional | | $309.03 | $1,071.52 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $4,677.35 / $9,120.11
| Facility | | $3,801.89 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,862.09 / $4,897.79
| Professional | | $302.00 | $1,862.09 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $2,511.89 / $5,888.44
| Facility | | $245.47 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,388.44 / $7,244.36
| Professional | | $2,041.74 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $4,265.80 / $6,760.83
| Facility | | $1,584.89 | $4,265.80 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,380.38 / $5,248.07
| Professional | | $213.80 | $1,380.38 | $5,248.07 |