- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $2,884.03 / $4,786.30
| Facility | | $288.40 | $2,884.03 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $446.68 / $1,548.82
| Professional | | $194.98 | $446.68 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $177.83 / $1,318.26 / $1,445.44
| Professional | 52 | $177.83 | $1,318.26 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $524.81 / $588.84
| Professional | 53 | $63.10 | $524.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $173.78 / $457.09
| Professional | | $165.96 | $173.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | 52 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | 53 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,884.03 / $4,897.79
| Facility | | $724.44 | $2,884.03 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $549.54
| Professional | | $239.88 | $416.87 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $446.68 / $741.31
| Professional | | $234.42 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $602.56
| Professional | | $32.36 | $33.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $812.83
| Facility | | $218.78 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $478.63 / $831.76
| Professional | | $239.88 | $478.63 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $3,235.94 / $5,248.07
| Facility | | $758.58 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $812.83
| Professional | | $251.19 | $436.52 | $812.83 |