- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,445.44 / $3,090.30
| Facility | | $398.11 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $426.58 / $912.01
| Professional | | $194.98 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $831.76
| Professional | 52 | $199.53 | $323.59 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $234.42
| Professional | 53 | $87.10 | $131.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $251.19
| Professional | | $151.36 | $190.55 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $281.84
| Professional | 53 | $190.55 | $190.55 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,584.89 / $2,137.96
| Facility | | $1,348.96 | $1,584.89 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $676.08
| Professional | | $295.12 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $61.66 / $128.82 / $151.36
| Professional | 53 | $61.66 | $128.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $436.52 / $851.14
| Professional | | $234.42 | $436.52 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,698.24 / $3,090.30
| Facility | | $630.96 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $363.08 / $660.69
| Professional | | $169.82 | $363.08 | $660.69 |