- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $4,897.79 / $12,302.69
| Facility | | $1,047.13 | $4,897.79 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $891.25 / $3,090.30
| Professional | | $371.54 | $891.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,995.26 / $2,454.71
| Professional | | $512.86 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $4,786.30 / $12,302.69
| Facility | | $891.25 | $4,786.30 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $478.63 / $2,454.71
| Professional | | $389.05 | $478.63 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $13,182.57 / $53,703.18
| Facility | | $5,495.41 | $13,182.57 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | 53 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $831.76 / $3,235.94
| Professional | | $389.05 | $831.76 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $13,182.57 / $23,442.29
| Facility | | $6,165.95 | $13,182.57 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,621.81 / $2,290.87
| Professional | | $446.68 | $1,621.81 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $323.59 / $1,071.52
| Professional | | $32.36 | $323.59 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,365.16 / $13,182.57 / $45,708.82
| Facility | | $4,365.16 | $13,182.57 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,000.00 / $2,630.27
| Professional | | $338.84 | $1,000.00 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $2,454.71
| Professional | | $316.23 | $549.54 | $2,454.71 |