- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $3,801.89 / $7,079.46
| Facility | | $933.25 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $741.31 / $1,698.24
| Professional | | $194.98 | $741.31 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $1,479.11
| Professional | | $204.17 | $363.08 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,290.87 / $5,888.44
| Facility | | $676.08 | $2,290.87 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $851.14 / $2,089.30
| Professional | | $275.42 | $851.14 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $707.95 / $1,230.27
| Facility | | $416.87 | $707.95 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $489.78 / $1,737.80
| Professional | | $239.88 | $489.78 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $794.33 / $1,584.89
| Professional | | $199.53 | $794.33 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $812.83
| Professional | 52 | $162.18 | $204.17 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $1,047.13
| Professional | 53 | $162.18 | $204.17 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $1,412.54 / $2,344.23
| Professional | | $190.55 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $2,454.71 / $4,786.30
| Facility | | $537.03 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $812.83 / $1,778.28
| Professional | | $213.80 | $812.83 | $1,778.28 |