- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,737.80 / $7,244.36
| Facility | | $323.59 | $1,737.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $363.08 / $1,023.29
| Professional | | $91.20 | $363.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $173.78 / $524.81
| Professional | | $100.00 | $173.78 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,905.46 / $3,801.89
| Facility | | $1,513.56 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $223.87 / $501.19
| Professional | | $114.82 | $223.87 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $758.58
| Professional | | $199.53 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $436.52 / $2,089.30
| Facility | | $151.36 | $436.52 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | 53 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $478.63 / $977.24
| Professional | | $251.19 | $478.63 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $478.63 / $724.44
| Professional | | $223.87 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $812.83
| Professional | | $194.98 | $309.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,348.96 / $1,584.89
| Facility | | $1,348.96 | $1,348.96 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,548.82 / $5,248.07
| Facility | | $870.96 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $602.56
| Professional | | $123.03 | $275.42 | $602.56 |