- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $2,344.23 / $8,511.38
| Facility | | $158.49 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $177.83 / $416.87
| Professional | | $81.28 | $177.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $117.49
| Professional | | $67.61 | $67.61 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $338.84
| Professional | | $102.33 | $199.53 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $218.78 / $302.00
| Professional | | $79.43 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $416.87
| Professional | | $102.33 | $199.53 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $489.78 / $12,022.64
| Facility | | $114.82 | $489.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 52 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 53 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $1,995.26
| Professional | | $213.80 | $407.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,288.25 / $2,691.53
| Facility | | $851.14 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $436.52
| Professional | | $104.71 | $218.78 | $436.52 |