- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $1,548.82 / $5,370.32
| Facility | | $169.82 | $1,548.82 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $213.80 / $660.69
| Professional | | $81.28 | $213.80 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $616.60
| Professional | | $144.54 | $245.47 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $323.59 / $630.96
| Professional | | $120.23 | $323.59 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $363.08 / $2,290.87
| Facility | | $123.03 | $363.08 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | 52 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 53 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $537.03 / $1,621.81
| Professional | | $229.09 | $537.03 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $446.68 / $616.60
| Professional | | $208.93 | $446.68 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $478.63 / $977.24
| Professional | | $213.80 | $478.63 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $181.97 / $446.68
| Professional | | $79.43 | $181.97 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,862.09 / $5,128.61
| Facility | | $1,023.29 | $1,862.09 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $269.15 / $691.83
| Professional | | $104.71 | $269.15 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $416.87 / $489.78
| Professional | | $162.18 | $416.87 | $489.78 |