- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $3,019.95 / $5,623.41
| Facility | | $1,230.27 | $3,019.95 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $331.13 / $776.25
| Professional | | $83.18 | $331.13 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Professional | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,819.70 / $3,388.44
| Facility | | $416.87 | $1,819.70 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $371.54 / $1,230.27
| Professional | | $81.28 | $371.54 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $234.42 / $588.84
| Professional | | $87.10 | $234.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $478.63 / $3,235.94
| Facility | | $93.33 | $478.63 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 52 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | 53 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $467.74 / $1,348.96
| Professional | | $363.08 | $467.74 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $4,677.35
| Facility | | $1,230.27 | $1,659.59 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $316.23 / $575.44
| Professional | | $81.28 | $316.23 | $575.44 |