- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $478.63 / $478.63
| Facility | | $190.55 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $407.38 / $707.95
| Professional | | $181.97 | $407.38 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,786.30 / $13,803.84
| Facility | | $2,630.27 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $4,570.88 / $7,413.10 / $20,892.96
| Facility | 50 | $4,570.88 | $7,413.10 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $776.25 / $1,659.59
| Professional | | $363.08 | $776.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $549.54 / $1,122.02 / $2,511.89
| Professional | 50 | $549.54 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,778.28 / $4,265.80
| Facility | | $1,258.93 | $1,778.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $870.96 / $1,995.26
| Professional | | $436.52 | $870.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,698.24 / $3,311.31
| Facility | | $1,348.96 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $812.83 / $1,819.70
| Professional | | $426.58 | $812.83 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $707.95 / $6,456.54
| Facility | | $275.42 | $707.95 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,071.52 / $2,818.38
| Professional | | $512.86 | $1,071.52 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,248.07 / $8,912.51
| Facility | | $1,584.89 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $691.83 / $1,659.59
| Professional | | $275.42 | $691.83 | $1,659.59 |