- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $407.38 / $3,090.30
| Facility | | $204.17 | $407.38 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $251.19 / $457.09
| Professional | | $128.82 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $316.23 / $741.31
| Professional | | $204.17 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $1,122.02
| Professional | 50 | $323.59 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $851.14 / $1,348.96
| Facility | | $724.44 | $851.14 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $575.44 / $1,174.90
| Professional | | $223.87 | $575.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $380.19 / $3,981.07
| Facility | | $151.36 | $380.19 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $446.68 / $741.31
| Professional | | $295.12 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,096.48
| Professional | 50 | $446.68 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $407.38 / $5,248.07
| Facility | | $151.36 | $407.38 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $2,884.03
| Professional | | $275.42 | $575.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $257.04
| Professional | | $32.36 | $33.11 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $3,890.45 / $4,570.88
| Facility | | $288.40 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $1,000.00
| Professional | | $331.13 | $588.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $426.58 / $891.25
| Professional | | $223.87 | $426.58 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,818.38 / $2,818.38
| Facility | | $1,905.46 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,288.25 / $2,951.21
| Professional | | $251.19 | $1,288.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $1,288.25
| Professional | | $645.65 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,348.96 / $2,630.27
| Professional | | $616.60 | $1,348.96 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,311.31 / $6,606.93
| Facility | | $2,754.23 | $3,311.31 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $346.74 / $977.24
| Professional | | $141.25 | $346.74 | $977.24 |