- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $3,715.35 / $8,511.38
| Facility | | $354.81 | $3,715.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $549.54 / $1,348.96
| Professional | | $173.78 | $549.54 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $1,122.02
| Professional | | $194.98 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $630.96 / $1,737.80
| Professional | | $245.47 | $630.96 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $512.86 / $1,258.93
| Facility | | $181.97 | $512.86 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | 52 | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $1,202.26 / $4,365.16
| Professional | | $251.19 | $1,202.26 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,096.48 / $1,621.81
| Professional | | $331.13 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $954.99 / $1,380.38
| Professional | | $331.13 | $954.99 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $363.08 / $1,698.24
| Professional | | $5.01 | $363.08 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $2,884.03 / $6,760.83
| Facility | | $2,398.83 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $416.87 / $1,348.96
| Professional | | $229.09 | $416.87 | $1,348.96 |