- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,754.23 / $6,309.57
| Facility | | $1,047.13 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $467.74 / $1,412.54
| Professional | | $316.23 | $467.74 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $380.19
| Professional | | $275.42 | $363.08 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,698.24 / $3,235.94
| Facility | | $436.52 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $758.58
| Professional | | $331.13 | $426.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,584.89 / $2,570.40
| Facility | | $1,202.26 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $758.58
| Professional | | $302.00 | $416.87 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $2,398.83
| Facility | | $302.00 | $416.87 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $676.08 / $6,025.60 / $6,025.60
| Facility | 52 | $676.08 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $165.96 / $1,513.56 / $1,513.56
| Facility | 53 | $165.96 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $2,454.71
| Professional | | $302.00 | $436.52 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,041.74 / $4,677.35
| Facility | | $1,122.02 | $2,041.74 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $676.08
| Professional | | $288.40 | $363.08 | $676.08 |