- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $1,621.81 / $6,456.54
| Facility | | $218.78 | $1,621.81 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $162.18 / $371.54
| Professional | | $69.18 | $162.18 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $67.61
| Professional | | $64.57 | $64.57 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,951.21 / $4,677.35
| Facility | | $1,862.09 | $2,951.21 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $275.42 / $380.19
| Professional | | $69.18 | $275.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $181.97 / $363.08
| Professional | | $79.43 | $181.97 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $257.04 / $1,905.46
| Facility | | $74.13 | $257.04 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | 52 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 53 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $288.40 / $2,089.30
| Professional | | $181.97 | $288.40 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $1,288.25 / $2,398.83
| Facility | | $371.54 | $1,288.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $141.25 / $309.03
| Professional | | $67.61 | $141.25 | $309.03 |