- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $2,290.87 / $6,309.57
| Facility | | $426.58 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $229.09 / $446.68
| Professional | | $117.49 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $147.91
| Professional | | $61.66 | $131.83 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,548.82 / $2,187.76
| Facility | | $1,096.48 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $389.05
| Professional | | $117.49 | $281.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $426.58
| Professional | | $141.25 | $251.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $316.23 / $2,344.23
| Facility | | $131.83 | $316.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 52 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | 53 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $2,137.96
| Professional | | $245.47 | $354.81 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,949.84 / $3,235.94
| Facility | | $478.63 | $1,949.84 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $213.80 / $380.19
| Professional | | $114.82 | $213.80 | $380.19 |