- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $199.53 / $2,290.87
| Facility | | $56.23 | $199.53 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $114.82 / $354.81
| Professional | | $58.88 | $114.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $89.13
| Professional | 52 | $48.98 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | 53 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $123.03
| Facility | | $60.26 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $288.40
| Professional | | $141.25 | $177.83 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $275.42
| Facility | | $83.18 | $147.91 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $758.58
| Professional | | $85.11 | $186.21 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $218.78
| Professional | | $138.04 | $162.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $204.17
| Professional | | $134.90 | $134.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $194.98
| Professional | | $102.33 | $141.25 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $257.04
| Professional | | $91.20 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $234.42
| Professional | | $120.23 | $144.54 | $234.42 |