- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $1,778.28 / $6,606.93
| Facility | | $102.33 | $1,778.28 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $147.91
| Professional | | $61.66 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $128.82
| Professional | | $79.43 | $107.15 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $478.63
| Facility | | $245.47 | $338.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $134.90
| Professional | | $61.66 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $120.23 / $158.49
| Professional | | $81.28 | $120.23 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $151.36 / $1,659.59
| Facility | | $69.18 | $151.36 | $1,659.59 |
- 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
- $87.10 / $120.23 / $758.58
| Professional | | $87.10 | $120.23 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $549.54 / $1,548.82
| Facility | | $138.04 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $134.90
| Professional | | $60.26 | $95.50 | $134.90 |