- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $912.01 / $2,454.71
| Facility | | $426.58 | $912.01 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $758.58
| Professional | | $239.88 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $117.49
| Professional | 53 | $114.82 | $114.82 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $213.80 / $407.38
| Professional | | $190.55 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $257.04 / $549.54 / $562.34
| Professional | 53 | $257.04 | $549.54 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $758.58
| Facility | | $691.83 | $691.83 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $1,380.38
| Facility | | $512.86 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $478.63 / $870.96
| Professional | | $263.03 | $478.63 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,479.11 / $2,884.03
| Facility | | $616.60 | $1,479.11 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $954.99
| Professional | | $239.88 | $426.58 | $954.99 |