- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,089.30 / $6,456.54
| Facility | | $208.93 | $2,089.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $190.55 / $588.84
| Professional | | $79.43 | $190.55 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $144.54
| Professional | | $63.10 | $81.28 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $173.78
| Professional | | $77.62 | $104.71 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $134.90
| Facility | | $77.62 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $346.74
| Professional | | $199.53 | $251.19 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $21,379.62
| Facility | | $141.25 | $141.25 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $208.93 / $426.58
| Professional | | $95.50 | $208.93 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,659.59 / $3,162.28
| Facility | | $588.84 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 52 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | 53 | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $194.98 / $398.11
| Professional | | $97.72 | $194.98 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $81.28
| Professional | | $32.36 | $33.11 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $436.52
| Facility | | $100.00 | $100.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $177.83 / $389.05
| Professional | | $75.86 | $177.83 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,698.24 / $4,073.80
| Facility | | $537.03 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $194.98 / $416.87
| Professional | | $89.13 | $194.98 | $416.87 |