- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,570.40 / $8,317.64
| Facility | | $758.58 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $676.08 / $3,235.94
| Professional | | $371.54 | $676.08 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $416.87 / $1,995.26
| Professional | | $380.19 | $416.87 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $12,882.50 / $20,892.96
| Facility | | $8,128.31 | $12,882.50 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,089.30 / $2,884.03
| Professional | | $398.11 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $616.60 / $2,691.53
| Professional | | $239.88 | $616.60 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $2,137.96 / $11,748.98
| Facility | | $398.11 | $2,137.96 | $11,748.98 |
- 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
- $1,258.93 / $1,949.84 / $16,982.44
| Professional | | $1,258.93 | $1,949.84 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $7,079.46 / $12,589.25
| Facility | | $1,949.84 | $7,079.46 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $1,023.29 / $2,137.96
| Professional | | $346.74 | $1,023.29 | $2,137.96 |