- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $2,290.87 / $7,943.28
| Facility | | $204.17 | $2,290.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $446.68 / $1,258.93
| Professional | | $147.91 | $446.68 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $181.97 / $194.98
| Professional | | $169.82 | $181.97 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $436.52 / $691.83
| Professional | | $158.49 | $436.52 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $275.42
| Facility | | $147.91 | $208.93 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $457.09 / $616.60
| Professional | | $181.97 | $457.09 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $275.42 / $275.42
| Facility | | $34.67 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | 53 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $707.95 / $2,754.23
| Professional | | $181.97 | $707.95 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,137.96 / $4,168.69
| Facility | | $588.84 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $478.63 / $977.24
| Professional | | $151.36 | $478.63 | $977.24 |