- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,818.38 / $6,760.83
| Facility | | $691.83 | $2,818.38 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $251.19
| Professional | | $64.57 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $239.88
| Professional | | $67.61 | $128.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,398.83 / $4,168.69
| Facility | | $794.33 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $123.03 / $186.21
| Professional | | $75.86 | $123.03 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $141.25
| Facility | | $87.10 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $173.78 / $288.40
| Professional | | $162.18 | $173.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $158.49 / $281.84
| Professional | | $91.20 | $158.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $134.90 / $229.09
| Professional | | $64.57 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $75.86
| Professional | 52 | $41.69 | $41.69 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,128.61 / $6,165.95
| Facility | | $3,388.44 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $275.42
| Professional | | $117.49 | $234.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,995.26 / $3,090.30
| Facility | | $426.58 | $1,995.26 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $251.19
| Professional | | $75.86 | $138.04 | $251.19 |