- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $5,370.32 / $9,549.93
| Facility | | $69.18 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $169.82
| Professional | | $44.67 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | 52 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | 53 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $138.04
| Professional | | $69.18 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | 53 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,398.83 / $4,168.69
| Facility | | $794.33 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $165.96
| Professional | | $60.26 | $102.33 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $158.49
| Professional | | $54.95 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $114.82
| Professional | | $41.69 | $72.44 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $64.57
| Professional | 52 | $39.81 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $64.57
| Professional | 53 | $39.81 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $165.96
| Professional | | $104.71 | $134.90 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $138.04
| Professional | | $48.98 | $81.28 | $138.04 |