- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,949.84 / $7,943.28
| Facility | | $407.38 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,047.13 / $2,754.23
| Professional | | $398.11 | $1,047.13 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,709.64 / $25,118.86 / $51,286.14
| Facility | | $8,709.64 | $25,118.86 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $26,915.35 / $42,657.95 / $120,226.44
| Facility | 50 | $26,915.35 | $42,657.95 | $120,226.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,041.74 / $5,128.61
| Professional | | $691.83 | $2,041.74 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,466.84 / $6,309.57 / $14,791.08
| Facility | | $4,466.84 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $2,511.89 / $6,918.31
| Professional | | $870.96 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $5,623.41 / $11,220.18
| Facility | | $4,677.35 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,290.87 / $5,623.41
| Professional | | $794.33 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $3,548.13 / $12,302.69
| Facility | | $630.96 | $3,548.13 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,981.07 / $8,317.64
| Professional | | $2,344.23 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,897.79 / $10,000.00 / $29,512.09
| Facility | | $4,897.79 | $10,000.00 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,995.26 / $6,025.60
| Professional | | $575.44 | $1,995.26 | $6,025.60 |