- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $3,548.13 / $7,762.47
| Facility | | $2,041.74 | $3,548.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $660.69 / $1,445.44
| Professional | | $218.78 | $660.69 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $239.88 / $1,047.13
| Professional | | $173.78 | $239.88 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,630.27 / $4,897.79
| Facility | | $676.08 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $676.08 / $1,318.26
| Professional | | $257.04 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,288.25 / $2,137.96
| Facility | | $977.24 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $537.03 / $1,202.26
| Professional | | $239.88 | $537.03 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $660.69 / $1,548.82
| Facility | | $218.78 | $660.69 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $4,897.79
| Facility | 52 | $812.83 | $812.83 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $5,370.32
| Professional | | $630.96 | $954.99 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,621.81 / $4,466.84
| Facility | | $1,000.00 | $1,621.81 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $588.84 / $1,122.02
| Professional | | $218.78 | $588.84 | $1,122.02 |