- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $812.83 / $2,137.96
| Facility | | $575.44 | $812.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $724.44 / $1,288.25
| Professional | | $512.86 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,365.16 / $10,715.19
| Facility | | $1,513.56 | $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
- $912.01 / $1,380.38 / $2,511.89
| Professional | | $912.01 | $1,380.38 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $3,801.89
| Professional | 50 | $1,348.96 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,818.38 / $6,606.93
| Facility | | $1,995.26 | $2,818.38 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,862.09 / $3,162.28
| Professional | | $1,122.02 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,630.27 / $5,248.07
| Facility | | $2,137.96 | $2,630.27 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,737.80 / $2,951.21
| Professional | | $1,096.48 | $1,737.80 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,071.52 / $2,238.72
| Facility | | $575.44 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,348.96 / $4,786.30
| Professional | | $724.44 | $1,348.96 | $4,786.30 |
- 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
- $691.83 / $1,174.90 / $2,290.87
| Professional | | $691.83 | $1,174.90 | $2,290.87 |