- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $2,454.71 / $5,370.32
| Facility | | $257.04 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $295.12 / $891.25
| Professional | | $77.62 | $295.12 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $794.33 / $1,096.48
| Professional | | $186.21 | $794.33 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $478.63 / $691.83
| Professional | | $87.10 | $478.63 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,071.52 / $5,128.61
| Facility | | $204.17 | $1,071.52 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Facility | 52 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | 53 | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $707.95 / $1,348.96
| Professional | | $218.78 | $707.95 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $794.33 / $1,071.52
| Professional | | $204.17 | $794.33 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $257.04 / $1,230.27
| Professional | | $223.87 | $257.04 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,290.87 / $3,981.07 / $6,309.57
| Facility | | $2,290.87 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $371.54 / $1,122.02
| Professional | | $97.72 | $371.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $870.96
| Professional | | $165.96 | $194.98 | $870.96 |