- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $2,511.89 / $5,623.41
| Facility | | $630.96 | $2,511.89 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $371.54 / $1,819.70
| Professional | | $141.25 | $371.54 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $154.88 / $1,000.00
| Professional | | $66.07 | $154.88 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $2,187.76 / $3,981.07
| Facility | | $588.84 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $954.99 / $2,041.74
| Professional | | $199.53 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $977.24 / $1,584.89
| Facility | | $446.68 | $977.24 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $295.12 / $1,905.46
| Professional | | $158.49 | $295.12 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $436.52 / $1,995.26
| Facility | | $151.36 | $436.52 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $3,715.35
| Facility | 52 | $549.54 | $549.54 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $933.25
| Facility | 53 | $138.04 | $138.04 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $1,230.27 / $7,943.28
| Professional | | $173.78 | $1,230.27 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,621.81 / $4,466.84
| Facility | | $1,122.02 | $1,621.81 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $1,584.89
| Professional | | $144.54 | $245.47 | $1,584.89 |