- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $1,995.26 / $6,456.54
| Facility | | $186.21 | $1,995.26 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $109.65 / $251.19
| Professional | | $53.70 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $229.09
| Professional | | $26.30 | $36.31 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,168.69
| Facility | | $1,698.24 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $173.78 / $239.88
| Professional | | $53.70 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $144.54 / $239.88
| Professional | | $64.57 | $144.54 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $181.97 / $1,905.46
| Facility | | $58.88 | $181.97 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 52 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $1,380.38
| Professional | | $134.90 | $194.98 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $1,288.25 / $2,398.83
| Facility | | $354.81 | $1,288.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $109.65 / $204.17
| Professional | | $52.48 | $109.65 | $204.17 |