- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,380.38 / $5,623.41
| Facility | | $218.78 | $1,380.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $389.05 / $933.25
| Professional | | $37.15 | $389.05 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $109.65
| Professional | | $100.00 | $100.00 | $109.65 |
- 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
- $218.78 / $288.40 / $457.09
| Professional | | $218.78 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $478.63 / $707.95
| Professional | | $190.55 | $478.63 | $707.95 |
- 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
- $213.80 / $398.11 / $741.31
| Professional | | $213.80 | $398.11 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $457.09 / $1,412.54
| Facility | | $208.93 | $457.09 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | 52 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 53 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $3,311.31
| Professional | | $416.87 | $724.44 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,148.15 / $2,754.23
| Facility | | $954.99 | $1,148.15 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $389.05 / $741.31
| Professional | | $199.53 | $389.05 | $741.31 |