- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $501.19
| Facility | | $389.05 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $478.63 / $812.83
| Professional | | $354.81 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $5,128.61 / $10,715.19
| Facility | | $2,187.76 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $5,495.41 / $8,709.64 / $25,118.86
| Facility | 50 | $5,495.41 | $8,709.64 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $912.01 / $1,584.89
| Professional | | $602.56 | $912.01 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,737.80 / $4,168.69
| Facility | | $1,230.27 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,202.26 / $1,995.26
| Professional | | $741.31 | $1,202.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,659.59 / $3,235.94
| Facility | | $1,348.96 | $1,659.59 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,174.90 / $1,862.09
| Professional | | $741.31 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $724.44 / $1,412.54
| Facility | | $407.38 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $851.14 / $2,754.23
| Professional | | $457.09 | $851.14 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $4,897.79 / $8,912.51
| Facility | | $1,621.81 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $758.58 / $1,513.56
| Professional | | $446.68 | $758.58 | $1,513.56 |