- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $204.17 / $512.86
| Facility | | $22.39 | $204.17 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $204.17 / $524.81
| Professional | | $64.57 | $204.17 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $190.55 / $229.09
| Professional | 52 | $30.20 | $190.55 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $660.69 / $1,819.70
| Facility | | $257.04 | $660.69 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $269.15 / $660.69
| Professional | | $117.49 | $269.15 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $1,698.24
| Facility | | $489.78 | $707.95 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $323.59 / $812.83
| Professional | | $138.04 | $323.59 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $1,348.96
| Facility | | $549.54 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $323.59 / $724.44
| Professional | | $138.04 | $323.59 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $302.00 / $1,737.80
| Facility | | $97.72 | $302.00 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $1,047.13
| Professional | | $234.42 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,819.70 / $3,715.35
| Facility | | $524.81 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $251.19 / $660.69
| Professional | | $93.33 | $251.19 | $660.69 |