- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,905.46 / $1,905.46
| Facility | | $181.97 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,659.59 / $2,691.53
| Professional | | $173.78 | $1,659.59 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $12,022.64 / $24,547.09
| Facility | | $4,677.35 | $12,022.64 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,318.26 / $5,248.07
| Professional | | $316.23 | $1,318.26 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $457.09 / $1,949.84 / $7,943.28
| Professional | 50 | $457.09 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $6,309.57 / $15,135.61
| Facility | | $4,365.16 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $2,570.40 / $6,918.31
| Professional | | $363.08 | $2,570.40 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,754.40 / $11,220.18
| Facility | | $4,677.35 | $5,754.40 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $2,344.23 / $6,456.54
| Professional | | $363.08 | $2,344.23 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $4,265.80 / $12,022.64
| Facility | | $309.03 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $4,073.80 / $8,128.31
| Professional | | $2,137.96 | $4,073.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,168.69
| Professional | 50 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $10,964.78 / $14,454.40
| Facility | | $1,584.89 | $10,964.78 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,659.59 / $6,025.60
| Professional | | $251.19 | $1,659.59 | $6,025.60 |