- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,202.26 / $2,454.71
| Facility | | $407.38 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $870.96 / $3,235.94
| Professional | | $380.19 | $870.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $12,302.69 / $30,199.52
| Facility | | $2,454.71 | $12,302.69 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,691.53 / $7,943.28
| Professional | | $758.58 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $8,709.64 / $20,892.96
| Facility | | $6,165.95 | $8,709.64 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $2,818.38 / $9,549.93
| Professional | | $912.01 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $7,943.28 / $15,848.93
| Facility | | $6,456.54 | $7,943.28 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,818.38 / $7,762.47
| Professional | | $891.25 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $2,344.23 / $8,128.31
| Facility | | $478.63 | $2,344.23 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 53 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,235.94 / $9,332.54
| Professional | | $1,778.28 | $3,235.94 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $9,332.54 / $16,595.87
| Facility | | $4,570.88 | $9,332.54 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,698.24 / $6,456.54
| Professional | | $537.03 | $1,698.24 | $6,456.54 |