- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $630.96 / $630.96
| Facility | | $478.63 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $1,148.15
| Professional | | $426.58 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $5,128.61 / $10,715.19
| Facility | | $2,691.53 | $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
- $741.31 / $1,122.02 / $1,995.26
| Professional | | $741.31 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,122.02 / $1,698.24 / $3,019.95
| Professional | 50 | $1,122.02 | $1,698.24 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,187.76 / $5,248.07
| Facility | | $1,548.82 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,513.56 / $2,511.89
| Professional | | $891.25 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,089.30 / $4,073.80
| Facility | | $1,698.24 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,479.11 / $2,344.23
| Professional | | $912.01 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,778.28
| Facility | | $575.44 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,023.29 / $2,454.71
| Professional | | $575.44 | $1,023.29 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $5,248.07 / $8,912.51
| Facility | | $3,019.95 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $954.99 / $1,905.46
| Professional | | $537.03 | $954.99 | $1,905.46 |