- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $199.53 / $1,288.25
| Facility | | $56.23 | $199.53 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $354.81
| Professional | | $64.57 | $123.03 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $128.82
| Professional | 52 | $48.98 | $70.79 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $102.33
| Professional | 53 | $24.55 | $40.74 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $1,479.11
| Facility | | $269.15 | $478.63 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $363.08
| Professional | | $114.82 | $186.21 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $891.25
| Facility | | $263.03 | $371.54 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $416.87
| Professional | | $131.83 | $239.88 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $691.83
| Facility | | $281.84 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $398.11
| Professional | | $131.83 | $218.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $1,445.44
| Facility | | $93.33 | $177.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | 52 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $512.86
| Professional | | $128.82 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,819.70 / $3,715.35
| Facility | | $524.81 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $346.74
| Professional | | $97.72 | $177.83 | $346.74 |