- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $154.88 / $489.78
| Facility | | $47.86 | $154.88 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $112.20 / $363.08
| Professional | | $58.88 | $112.20 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $125.89
| Professional | 52 | $46.77 | $46.77 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46,773.51 / $75,857.76 / $95,499.26
| Facility | | $46,773.51 | $75,857.76 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $181.97
| Professional | | $109.65 | $154.88 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $181.97
| Professional | | $61.66 | $109.65 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $213.80
| Facility | | $117.49 | $186.21 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $213.80
| Professional | | $117.49 | $186.21 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $177.83
| Facility | | $58.88 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $186.21
| Professional | | $67.61 | $109.65 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $199.53
| Professional | | $100.00 | $128.82 | $199.53 |