- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $5,623.41 / $9,120.11
| Facility | | $2,344.23 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | 52 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $602.56 / $3,162.28
| Professional | | $218.78 | $602.56 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $109.65
| Professional | 53 | $69.18 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $426.58
| Professional | | $275.42 | $275.42 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $7,585.78 / $12,882.50
| Facility | | $2,754.23 | $7,585.78 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $1,380.38
| Professional | | $223.87 | $302.00 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $537.03 / $3,311.31
| Professional | | $257.04 | $537.03 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,513.56 / $2,137.96
| Professional | | $323.59 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $10,232.93 / $16,218.10
| Facility | | $6,606.93 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $831.76 / $2,041.74
| Professional | | $190.55 | $831.76 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $6,165.95 / $10,471.29
| Facility | | $2,884.03 | $6,165.95 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $549.54 / $2,290.87
| Professional | | $223.87 | $549.54 | $2,290.87 |