- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,019.95 / $6,760.83
| Facility | | $1,380.38 | $3,019.95 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $223.87 / $933.25
| Professional | | $67.61 | $223.87 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $70.79 / $190.55 / $316.23
| Professional | 52 | $70.79 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $134.90 / $169.82
| Professional | | $48.98 | $134.90 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,778.28 / $3,388.44
| Facility | | $416.87 | $1,778.28 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $141.25 / $346.74
| Professional | | $47.86 | $141.25 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Facility | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $165.96 / $331.13
| Professional | | $67.61 | $165.96 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $208.93 / $1,698.24
| Facility | | $67.61 | $208.93 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 52 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $245.47 / $1,380.38
| Professional | | $169.82 | $245.47 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $933.25 / $2,137.96
| Facility | | $169.82 | $933.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $154.88 / $295.12
| Professional | | $64.57 | $154.88 | $295.12 |