- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $7,943.28 / $13,489.63
| Facility | | $1,174.90 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $562.34 / $1,905.46
| Professional | | $169.82 | $562.34 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,365.16 / $8,511.38
| Facility | | $3,311.31 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $467.74 / $1,122.02
| Professional | | $204.17 | $467.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,230.27 / $1,737.80
| Professional | | $407.38 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $954.99 / $7,413.10
| Facility | | $245.47 | $954.99 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | 52 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,202.26 / $3,467.37
| Professional | | $758.58 | $1,202.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,096.48 / $1,737.80
| Professional | | $389.05 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $1,258.93
| Professional | | $389.05 | $389.05 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $4,786.30 / $7,585.78
| Facility | | $3,890.45 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $741.31 / $1,412.54
| Professional | | $263.03 | $741.31 | $1,412.54 |