- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $3,235.94 / $5,623.41
| Facility | | $1,023.29 | $3,235.94 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $645.65 / $1,445.44
| Professional | | $218.78 | $645.65 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,258.93 / $5,128.61
| Facility | | $56.23 | $1,258.93 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | 52 | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $691.83 / $2,187.76
| Professional | | $234.42 | $691.83 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $602.56
| Facility | | $257.04 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $602.56 / $1,513.56
| Professional | | $257.04 | $602.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $741.31 / $2,187.76
| Facility | | $676.08 | $741.31 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $562.34 / $1,659.59
| Professional | | $251.19 | $562.34 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $288.40 / $3,311.31
| Facility | | $186.21 | $288.40 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,122.02 / $1,659.59
| Professional | | $794.33 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $776.25 / $1,995.26
| Professional | | $239.88 | $776.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,818.38 / $3,162.28
| Facility | | $1,819.70 | $2,818.38 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,258.93 / $5,128.61
| Facility | | $56.23 | $1,258.93 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | 52 | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $691.83 / $2,187.76
| Professional | | $234.42 | $691.83 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,691.53 / $7,585.78
| Facility | | $676.08 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $691.83 / $2,041.74
| Professional | | $245.47 | $691.83 | $2,041.74 |