- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $8,511.38 / $15,135.61
| Facility | | $478.63 | $8,511.38 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $562.34 / $2,951.21
| Professional | | $208.93 | $562.34 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $478.63
| Professional | | $398.11 | $398.11 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $9,549.93 / $20,892.96
| Facility | | $8,128.31 | $9,549.93 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $954.99 / $2,290.87
| Professional | | $263.03 | $954.99 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,754.23 / $3,630.78
| Professional | | $524.81 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,905.46 / $9,549.93
| Facility | | $323.59 | $1,905.46 | $9,549.93 |
- 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
- $562.34 / $2,344.23 / $4,466.84
| Professional | | $562.34 | $2,344.23 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,187.76 / $3,630.78
| Professional | | $512.86 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $2,511.89
| Professional | | $501.19 | $501.19 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Facility | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,585.78 / $9,549.93
| Facility | | $6,918.31 | $7,585.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,548.82 / $2,884.03
| Professional | | $346.74 | $1,548.82 | $2,884.03 |