- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $707.95 / $3,801.89
| Facility | | $123.03 | $707.95 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $295.12 / $660.69
| Professional | | $83.18 | $295.12 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $245.47 / $331.13
| Professional | | $63.10 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $123.03
| Facility | | $75.86 | $107.15 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $446.68
| Professional | | $91.20 | $154.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $141.25 / $141.25
| Facility | | $34.67 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Facility | 52 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | 53 | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $478.63 / $1,698.24
| Professional | | $104.71 | $478.63 | $1,698.24 |
- 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
- $524.81 / $2,137.96 / $11,481.54
| Facility | | $524.81 | $2,137.96 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $269.15 / $691.83
| Professional | | $97.72 | $269.15 | $691.83 |