- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $691.83 / $1,995.26
| Facility | | $131.83 | $691.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $208.93
| Professional | | $58.88 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | 52 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $50.12
| Professional | 53 | $21.38 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $213.80
| Professional | | $72.44 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 53 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $389.05
| Facility | | $53.70 | $53.70 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $199.53
| Professional | | $69.18 | $131.83 | $199.53 |
- 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
- $269.15 / $537.03 / $1,479.11
| Facility | | $269.15 | $537.03 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $229.09
| Professional | | $66.07 | $112.20 | $229.09 |