- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $14,454.40
| Facility | | $346.74 | $645.65 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $954.99 / $1,513.56
| Facility | | $812.83 | $954.99 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 52 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 53 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $3,715.35
| Facility | | $309.03 | $489.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $537.03 / $8,317.64
| Facility | | $316.23 | $537.03 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | 52 | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 53 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $5,754.40 / $7,762.47
| Facility | | $691.83 | $5,754.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $660.69 / $1,023.29
| Professional | | $363.08 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $10,715.19 / $10,715.19
| Facility | | $537.03 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $436.52 / $5,754.40 / $8,511.38
| Facility | 52 | $436.52 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $107.15 / $1,445.44 / $2,137.96
| Facility | 53 | $107.15 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Professional | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $7,585.78 / $9,120.11
| Facility | | $4,073.80 | $7,585.78 | $9,120.11 |