- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,659.59 / $5,011.87
| Facility | | $199.53 | $1,659.59 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $251.19 / $758.58
| Professional | | $97.72 | $251.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $309.03 / $851.14
| Professional | | $128.82 | $309.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $331.13 / $891.25
| Professional | | $100.00 | $331.13 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $436.52 / $2,398.83
| Facility | | $144.54 | $436.52 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 52 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | 53 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $562.34 / $2,137.96
| Professional | | $281.84 | $562.34 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $588.84 / $794.33
| Professional | | $257.04 | $588.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $575.44 / $831.76
| Professional | | $208.93 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,949.84 / $3,311.31
| Facility | | $977.24 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $263.03 / $602.56
| Professional | | $97.72 | $263.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,570.40 / $6,165.95
| Facility | | $1,174.90 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $295.12 / $691.83
| Professional | | $114.82 | $295.12 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $245.47 / $645.65
| Professional | | $204.17 | $245.47 | $645.65 |