- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $2,570.40 / $10,964.78
| Facility | | $223.87 | $2,570.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $478.63 / $1,659.59
| Professional | | $213.80 | $478.63 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $6,918.31 / $16,982.44
| Facility | | $1,318.26 | $6,918.31 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,348.96 / $4,168.69
| Professional | | $389.05 | $1,348.96 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,786.30 / $11,220.18
| Facility | | $2,951.21 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,949.84 / $5,248.07
| Professional | | $467.74 | $1,949.84 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,548.13 / $4,168.69 / $8,511.38
| Facility | | $3,548.13 | $4,168.69 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,445.44 / $4,570.88
| Professional | | $467.74 | $1,445.44 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $2,187.76 / $7,762.47
| Facility | | $331.13 | $2,187.76 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | 52 | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,398.83 / $6,025.60
| Professional | | $1,148.15 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $5,888.44 / $9,549.93
| Facility | | $1,584.89 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,174.90 / $4,073.80
| Professional | | $323.59 | $1,174.90 | $4,073.80 |