- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $426.58 / $5,495.41
| Facility | | $144.54 | $426.58 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $120.23 / $213.80
| Professional | | $64.57 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $39.81 / $44.67 / $50.12
| Professional | 53 | $39.81 | $44.67 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $302.00 / $602.56
| Facility | | $89.13 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $158.49 / $199.53
| Professional | | $114.82 | $158.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $177.83
| Professional | | $89.13 | $125.89 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $138.04 / $426.58
| Facility | | $85.11 | $138.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $208.93
| Professional | | $72.44 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $39.81 / $44.67 / $50.12
| Professional | 53 | $39.81 | $44.67 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $467.74 / $630.96
| Facility | | $363.08 | $467.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $165.96
| Professional | | $97.72 | $120.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $120.23 / $363.08
| Professional | | $89.13 | $120.23 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $8,317.64 / $9,332.54
| Facility | | $1,819.70 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $181.97
| Professional | | $79.43 | $120.23 | $181.97 |