- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $6,456.54 / $12,882.50
| Facility | | $457.09 | $6,456.54 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $707.95 / $1,698.24
| Professional | | $223.87 | $707.95 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $6,025.60 / $11,748.98
| Facility | | $4,677.35 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $588.84 / $1,380.38
| Professional | | $251.19 | $588.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $691.83 / $1,995.26
| Professional | | $316.23 | $691.83 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $676.08 / $1,621.81
| Facility | | $229.09 | $676.08 | $1,621.81 |
- 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
- $741.31 / $1,479.11 / $5,370.32
| Professional | | $741.31 | $1,479.11 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,348.96 / $1,995.26
| Professional | | $478.63 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,174.90 / $1,698.24
| Professional | | $426.58 | $1,174.90 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $851.14 / $2,041.74
| Professional | | $5.01 | $851.14 | $2,041.74 |
- 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
- $295.12 / $741.31 / $1,659.59
| Professional | | $295.12 | $741.31 | $1,659.59 |