- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $3,311.31 / $5,128.61
| Facility | | $1,202.26 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $204.17 / $489.78
| Professional | | $104.71 | $204.17 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $186.21
| Facility | | $112.20 | $138.04 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $645.65 / $676.08
| Professional | | $123.03 | $645.65 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $186.21 / $186.21
| Facility | | $34.67 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 52 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Facility | 53 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $323.59 / $2,691.53
| Professional | | $123.03 | $323.59 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,344.23 / $6,025.60
| Facility | | $1,174.90 | $2,344.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 50 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Professional | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,737.80
| Facility | | $691.83 | $691.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $229.09 / $977.24
| Professional | | $97.72 | $229.09 | $977.24 |