- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $724.44 / $5,888.44
| Facility | | $123.03 | $724.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $147.91 / $467.74
| Professional | | $72.44 | $147.91 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $89.13 / $131.83 / $389.05
| Professional | 52 | $89.13 | $131.83 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $120.23
| Professional | 53 | $39.81 | $54.95 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $213.80 / $288.40
| Professional | | $141.25 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $173.78 / $323.59
| Professional | | $79.43 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $1,621.81
| Facility | | $123.03 | $257.04 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 52 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | 53 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $194.98 / $467.74
| Professional | | $117.49 | $194.98 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $275.42
| Professional | | $154.88 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $275.42
| Professional | | $169.82 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $218.78 / $269.15
| Professional | | $3.02 | $218.78 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,023.29 / $2,344.23
| Facility | | $302.00 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $263.03
| Professional | | $74.13 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $223.87
| Professional | | $120.23 | $141.25 | $223.87 |