- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $2,089.30 / $5,623.41
| Facility | | $660.69 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $204.17 / $707.95
| Professional | | $70.79 | $204.17 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $131.83
| Professional | | $60.26 | $70.79 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,698.24 / $3,235.94
| Facility | | $416.87 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $269.15 / $524.81
| Professional | | $85.11 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $549.54 / $912.01
| Facility | | $331.13 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $165.96 / $457.09
| Professional | | $72.44 | $165.96 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $194.98 / $575.44
| Facility | | $70.79 | $194.98 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $2,089.30
| Facility | 52 | $263.03 | $263.03 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $524.81
| Facility | 53 | $66.07 | $66.07 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $323.59 / $2,089.30
| Professional | | $162.18 | $323.59 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,230.27 / $3,090.30
| Facility | | $707.95 | $1,230.27 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $151.36 / $371.54
| Professional | | $67.61 | $151.36 | $371.54 |