- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,715.35 / $12,882.50
| Facility | | $1,000.00 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $501.19 / $812.83
| Professional | | $186.21 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $4,073.80 / $7,585.78
| Facility | | $724.44 | $4,073.80 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $501.19 / $870.96
| Professional | | $165.96 | $501.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $407.38 / $1,023.29
| Professional | | $204.17 | $407.38 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $7,762.47
| Facility | | $54.95 | $56.23 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | 52 | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $5,248.07
| Professional | | $4,786.30 | $4,786.30 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $954.99 / $5,754.40
| Facility | | $218.78 | $954.99 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $630.96 / $1,096.48
| Professional | | $199.53 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $147.91
| Professional | | $32.36 | $33.11 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $602.56 / $1,258.93
| Facility | | $199.53 | $602.56 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $416.87 / $1,023.29
| Professional | | $199.53 | $416.87 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $4,677.35 / $8,709.64
| Facility | | $1,737.80 | $4,677.35 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $446.68 / $933.25
| Professional | | $165.96 | $446.68 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $588.84
| Professional | | $549.54 | $549.54 | $588.84 |