- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,137.96 / $5,495.41
| Facility | | $630.96 | $2,137.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $263.03 / $794.33
| Professional | | $112.20 | $263.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $223.87
| Professional | | $93.33 | $120.23 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,584.89 / $3,019.95
| Facility | | $416.87 | $1,584.89 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $257.04 / $602.56
| Professional | | $125.89 | $257.04 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $562.34 / $933.25
| Facility | | $331.13 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $269.15 / $489.78
| Professional | | $131.83 | $269.15 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $851.14
| Facility | | $123.03 | $275.42 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $2,187.76
| Facility | 52 | $446.68 | $446.68 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $537.03
| Facility | 53 | $109.65 | $109.65 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $2,137.96
| Professional | | $257.04 | $398.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,584.89 / $4,466.84
| Facility | | $776.25 | $1,584.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $245.47 / $436.52
| Professional | | $120.23 | $245.47 | $436.52 |