- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $14,454.40
| Facility | | $316.23 | $588.84 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $10,232.93 / $18,197.01
| Facility | | $4,677.35 | $10,232.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $851.14 / $1,380.38
| Facility | | $741.31 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 52 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $398.11 / $3,981.07
| Facility | | $281.84 | $398.11 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $5,754.40
| Facility | | $281.84 | $436.52 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | 52 | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,265.80 / $4,570.88
| Facility | | $2,818.38 | $4,265.80 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $912.01
| Professional | | $331.13 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $16,218.10 / $23,988.33
| Facility | | $489.78 | $16,218.10 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $389.05 / $12,882.50 / $19,054.61
| Facility | 52 | $389.05 | $12,882.50 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,630.78 / $7,244.36
| Facility | | $2,884.03 | $3,630.78 | $7,244.36 |