- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $549.54 / $1,513.56
| Facility | | $524.81 | $549.54 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $870.96
| Professional | | $489.78 | $575.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,778.28 / $4,168.69
| Facility | | $724.44 | $1,778.28 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,096.48 / $1,819.70
| Professional | | $758.58 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $1,621.81 / $2,754.23
| Professional | 50 | $1,122.02 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,905.46 / $4,570.88
| Facility | | $1,348.96 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,445.44 / $2,344.23
| Professional | | $870.96 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,819.70 / $3,548.13
| Facility | | $1,479.11 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,288.25 / $2,041.74
| Professional | | $870.96 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $933.25 / $1,479.11
| Facility | | $588.84 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $977.24 / $3,715.35
| Professional | | $524.81 | $977.24 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,949.84 / $3,981.07
| Facility | | $1,023.29 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $933.25 / $1,862.09
| Professional | | $537.03 | $933.25 | $1,862.09 |