- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $1,862.09 / $5,011.87
| Facility | | $95.50 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $162.18 / $549.54
| Professional | | $72.44 | $162.18 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $281.84
| Professional | 52 | $218.78 | $218.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $50.12 / $102.33 / $125.89
| Professional | 53 | $50.12 | $102.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $208.93
| Professional | | $54.95 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | 52 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $181.97
| Professional | | $75.86 | $117.49 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $169.82
| Professional | | $70.79 | $104.71 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $95.50 / $158.49
| Professional | | $0.71 | $95.50 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $81.28 / $144.54
| Professional | | $0.60 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $97.72 / $97.72
| Professional | | $53.70 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $1,047.13 / $2,041.74
| Facility | | $60.26 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $194.98
| Professional | | $64.57 | $107.15 | $194.98 |