- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,479.11 / $6,456.54
| Facility | | $467.74 | $1,479.11 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $588.84 / $1,071.52
| Professional | | $251.19 | $588.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $295.12
| Professional | | $263.03 | $263.03 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $3,467.37 / $5,495.41
| Facility | | $2,187.76 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $676.08 / $933.25
| Professional | | $251.19 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $933.25
| Professional | | $251.19 | $489.78 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $691.83 / $2,754.23
| Facility | | $275.42 | $691.83 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | 52 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 53 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $4,897.79
| Professional | | $588.84 | $812.83 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,995.26 / $3,235.94
| Facility | | $524.81 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $501.19 / $870.96
| Professional | | $245.47 | $501.19 | $870.96 |