- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,884.03 / $6,760.83
| Facility | | $1,318.26 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $1,380.38
| Professional | | $257.04 | $616.60 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $467.74
| Professional | | $229.09 | $229.09 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $2,290.87 / $4,265.80
| Facility | | $549.54 | $2,290.87 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $630.96 / $1,380.38
| Professional | | $295.12 | $630.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $707.95 / $1,174.90
| Facility | | $446.68 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $549.54 / $1,148.15
| Professional | | $281.84 | $549.54 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $1,479.11
| Facility | | $257.04 | $616.60 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $2,691.53
| Facility | 52 | $933.25 | $933.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $676.08
| Facility | 53 | $229.09 | $229.09 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $933.25 / $4,897.79
| Professional | | $575.44 | $933.25 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $4,466.84
| Facility | | $1,000.00 | $1,584.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $549.54 / $1,000.00
| Professional | | $257.04 | $549.54 | $1,000.00 |