- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,584.89 / $5,370.32
| Facility | | $331.13 | $1,584.89 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $1,479.11
| Professional | | $144.54 | $263.03 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $194.98
| Professional | | $131.83 | $165.96 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $4,365.16 / $6,918.31
| Facility | | $2,754.23 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $1,071.52 / $1,479.11
| Professional | | $147.91 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $1,513.56
| Professional | | $173.78 | $257.04 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $933.25 / $2,951.21
| Facility | | $165.96 | $933.25 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 52 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | 53 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,148.15 / $7,943.28
| Professional | | $194.98 | $1,148.15 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,995.26 / $3,890.45
| Facility | | $645.65 | $1,995.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $239.88 / $1,288.25
| Professional | | $138.04 | $239.88 | $1,288.25 |