- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $2,511.89 / $8,317.64
| Facility | | $109.65 | $2,511.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $190.55 / $331.13
| Professional | | $61.66 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 52 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $134.90 / $354.81
| Professional | | $38.02 | $134.90 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $245.47 / $1,071.52
| Facility | | $229.09 | $245.47 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $288.40
| Professional | | $109.65 | $109.65 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $177.83 / $363.08
| Professional | | $67.61 | $177.83 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $223.87 / $1,096.48
| Facility | | $61.66 | $223.87 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $1,380.38
| Professional | | $186.21 | $251.19 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $380.19 / $1,905.46
| Facility | | $147.91 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $158.49 / $288.40
| Professional | | $70.79 | $158.49 | $288.40 |