- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $5,888.44 / $12,302.69
| Facility | | $346.74 | $5,888.44 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $676.08 / $2,290.87
| Professional | | $218.78 | $676.08 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $338.84 / $363.08
| Professional | | $302.00 | $338.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,348.96 / $3,162.28
| Professional | | $346.74 | $1,348.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $724.44 / $2,511.89
| Professional | | $281.84 | $724.44 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $1,000.00 / $2,041.74
| Facility | | $234.42 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $6,918.31 / $9,332.54
| Facility | | $6,918.31 | $6,918.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $363.08 / $1,819.70
| Professional | | $331.13 | $363.08 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $14,791.08 / $23,442.29
| Facility | | $6,025.60 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,096.48 / $2,344.23
| Professional | | $239.88 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $15,488.17 / $15,488.17
| Facility | | $56.23 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | 52 | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8,317.64 / $9,772.37 / $9,772.37
| Professional | | $8,317.64 | $9,772.37 | $9,772.37 |