- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $1,819.70 / $4,265.80
| Facility | | $87.10 | $1,819.70 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $138.04 / $457.09
| Professional | | $53.70 | $138.04 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $64.57
| Professional | | $26.30 | $43.65 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,479.11 / $3,235.94
| Facility | | $758.58 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $251.19
| Professional | | $63.10 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $173.78 / $302.00
| Professional | | $57.54 | $173.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,677.35
| Facility | | $1,698.24 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $144.54 / $309.03
| Professional | | $60.26 | $144.54 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $169.82 / $1,122.02
| Facility | | $56.23 | $169.82 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 52 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $295.12 / $1,380.38
| Professional | | $144.54 | $295.12 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $2,187.76
| Facility | | $741.31 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $134.90 / $295.12
| Professional | | $54.95 | $134.90 | $295.12 |