- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $562.34 / $9,120.11
| Facility | | $234.42 | $562.34 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $398.11
| Professional | | $77.62 | $128.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $281.84
| Professional | 52 | $50.12 | $70.79 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $120.23
| Professional | 53 | $24.55 | $41.69 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $93.33
| Professional | | $83.18 | $83.18 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $588.84
| Facility | | $190.55 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $169.82
| Professional | | $56.23 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $199.53
| Professional | | $83.18 | $125.89 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $123.03 / $208.93
| Facility | | $75.86 | $123.03 | $208.93 |
- 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
- $199.53 / $1,122.02 / $4,677.35
| Facility | | $199.53 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $186.21
| Professional | | $67.61 | $109.65 | $186.21 |