- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $363.08
| Facility | | $194.98 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $288.40 / $537.03
| Professional | | $169.82 | $288.40 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $4,365.16 / $10,715.19
| Facility | | $1,071.52 | $4,365.16 | $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
- $309.03 / $549.54 / $1,023.29
| Professional | | $309.03 | $549.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $467.74 / $831.76 / $1,548.82
| Professional | 50 | $467.74 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,258.93 / $3,019.95
| Facility | | $812.83 | $1,258.93 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $741.31 / $1,412.54
| Professional | | $380.19 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,174.90 / $2,290.87
| Facility | | $954.99 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,258.93
| Professional | | $398.11 | $676.08 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $407.38 / $1,023.29
| Facility | | $208.93 | $407.38 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $1,348.96
| Professional | | $316.23 | $588.84 | $1,348.96 |
- 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
- $239.88 / $478.63 / $1,023.29
| Professional | | $239.88 | $478.63 | $1,023.29 |