- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,162.28 / $6,760.83
| Facility | | $1,737.80 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $1,412.54
| Professional | | $380.19 | $489.78 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $398.11
| Professional | | $389.05 | $389.05 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,454.71 / $4,570.88
| Facility | | $549.54 | $2,454.71 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $575.44 / $1,096.48
| Professional | | $501.19 | $575.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $512.86 / $851.14
| Professional | | $389.05 | $512.86 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $4,168.69
| Facility | | $407.38 | $588.84 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $6,760.83
| Facility | 52 | $870.96 | $870.96 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $851.14
| Facility | AS | $109.65 | $109.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $524.81 / $3,235.94
| Professional | | $380.19 | $524.81 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,884.03 / $5,370.32
| Facility | | $2,238.72 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $776.25
| Professional | | $363.08 | $446.68 | $776.25 |