- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $1,905.46 / $4,897.79
| Facility | | $97.72 | $1,905.46 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $181.97 / $602.56
| Professional | | $69.18 | $181.97 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $107.15
| Professional | | $30.90 | $64.57 | $107.15 |
- 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
- $81.28 / $151.36 / $389.05
| Professional | | $81.28 | $151.36 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $208.93 / $457.09
| Professional | | $70.79 | $208.93 | $457.09 |
- 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
- $77.62 / $181.97 / $436.52
| Professional | | $77.62 | $181.97 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $251.19 / $1,122.02
| Facility | | $72.44 | $251.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | 52 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 53 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $446.68 / $2,089.30
| Professional | | $199.53 | $446.68 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $2,089.30
| Facility | | $741.31 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $181.97 / $446.68
| Professional | | $70.79 | $181.97 | $446.68 |