- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $3,548.13 / $8,511.38
| Facility | | $380.19 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $630.96 / $1,412.54
| Professional | | $218.78 | $630.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $199.53 / $239.88
| Professional | | $186.21 | $199.53 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,479.11 / $4,168.69
| Facility | | $758.58 | $1,479.11 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $524.81 / $1,096.48
| Professional | | $223.87 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $776.25 / $1,148.15
| Professional | | $213.80 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $9,332.54 / $10,471.29
| Facility | | $4,570.88 | $9,332.54 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $478.63 / $1,202.26
| Professional | | $239.88 | $478.63 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $691.83 / $2,041.74
| Facility | | $229.09 | $691.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | 52 | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,122.02 / $5,370.32
| Professional | | $691.83 | $1,122.02 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $2,951.21
| Facility | | $1,071.52 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $575.44 / $1,230.27
| Professional | | $223.87 | $575.44 | $1,230.27 |