- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $933.25 / $4,897.79
| Facility | | $128.82 | $933.25 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $229.09 / $549.54
| Professional | | $77.62 | $229.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $147.91 / $190.55
| Professional | 52 | $45.71 | $147.91 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $26.30 / $34.67 / $34.67
| Professional | 53 | $26.30 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $199.53 / $213.80
| Professional | | $75.86 | $199.53 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $23.99
| Facility | | $20.42 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $354.81
| Professional | | $74.13 | $125.89 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $208.93 / $302.00
| Professional | | $81.28 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $851.14 / $4,897.79
| Facility | | $104.71 | $851.14 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $234.42 / $446.68
| Professional | | $85.11 | $234.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $147.91 / $190.55
| Professional | 52 | $45.71 | $147.91 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | 53 | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $169.82 / $302.00
| Professional | | $74.13 | $169.82 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,584.89 / $3,801.89
| Facility | | $549.54 | $1,584.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $316.23
| Professional | | $102.33 | $199.53 | $316.23 |