- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,344.23 / $6,309.57
| Facility | | $630.96 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $288.40 / $977.24
| Professional | | $74.13 | $288.40 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $138.04 / $229.09
| Professional | | $72.44 | $138.04 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,949.84 / $3,981.07
| Facility | | $549.54 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $758.58
| Professional | | $107.15 | $223.87 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $562.34 / $933.25
| Facility | | $426.58 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $316.23 / $630.96
| Professional | | $147.91 | $316.23 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $346.74 / $954.99
| Facility | | $138.04 | $346.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $2,187.76
| Facility | 52 | $501.19 | $501.19 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $537.03
| Facility | 53 | $123.03 | $123.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $489.78 / $2,754.23
| Professional | | $288.40 | $489.78 | $2,754.23 |
- 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
- $134.90 / $302.00 / $562.34
| Professional | | $134.90 | $302.00 | $562.34 |