- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $5,623.41 / $15,848.93
| Facility | | $407.38 | $5,623.41 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $2,041.74
| Professional | | $234.42 | $512.86 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $10,000.00 / $17,378.01
| Facility | | $2,344.23 | $10,000.00 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $870.96 / $1,737.80
| Professional | | $218.78 | $870.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,071.52 / $1,548.82
| Professional | | $213.80 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14,454.40 / $15,135.61 / $18,620.87
| Facility | | $14,454.40 | $15,135.61 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $501.19 / $2,344.23
| Professional | | $257.04 | $501.19 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $1,584.89 / $12,882.50
| Facility | | $54.95 | $1,584.89 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | 52 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $2,137.96 / $8,709.64
| Professional | | $1,202.26 | $2,137.96 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $4,265.80 / $12,882.50
| Facility | | $2,884.03 | $4,265.80 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,047.13 / $2,398.83
| Professional | | $269.15 | $1,047.13 | $2,398.83 |