- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,348.96 / $7,585.78
| Facility | | $302.00 | $1,348.96 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $724.44 / $1,698.24
| Professional | | $194.98 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $812.83 / $1,737.80
| Professional | | $263.03 | $812.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,318.26 / $2,570.40
| Professional | | $309.03 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $891.25 / $1,584.89
| Facility | | $323.59 | $891.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 52 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Facility | 53 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $616.60 / $1,862.09
| Professional | | $245.47 | $616.60 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $707.95 / $1,659.59
| Facility | | $199.53 | $707.95 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $1,659.59 / $2,398.83
| Professional | | $1,659.59 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $1,258.93 / $1,412.54
| Professional | | $281.84 | $1,258.93 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $2,570.40 / $6,165.95
| Facility | | $416.87 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $691.83 / $1,584.89
| Professional | | $204.17 | $691.83 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $5,011.87 / $5,011.87
| Facility | | $56.23 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 52 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 53 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $6,165.95 / $6,760.83
| Professional | | $6,165.95 | $6,165.95 | $6,760.83 |