- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $8,511.38 / $20,417.38
| Facility | | $1,698.24 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $891.25 / $1,819.70
| Professional | | $537.03 | $891.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8,912.51 / $14,791.08 / $20,892.96
| Facility | | $8,912.51 | $14,791.08 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $707.95 / $1,174.90
| Professional | | $562.34 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $512.86 / $812.83
| Professional | | $446.68 | $512.86 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $15,488.17 / $22,908.68
| Facility | | $3,715.35 | $15,488.17 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $891.25 / $1,318.26
| Professional | | $575.44 | $891.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $3,019.95 / $32,359.37
| Facility | | $630.96 | $3,019.95 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,023.29 / $30,199.52 / $30,199.52
| Facility | 52 | $1,023.29 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $257.04 / $7,585.78 / $7,585.78
| Facility | 53 | $257.04 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,023.29 / $3,548.13
| Professional | | $562.34 | $1,023.29 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,801.89 / $25,118.86
| Facility | | $2,884.03 | $3,801.89 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $912.01 / $1,380.38
| Professional | | $562.34 | $912.01 | $1,380.38 |