- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $316.23 / $6,760.83
| Facility | | $93.33 | $316.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $208.93 / $602.56
| Professional | | $61.66 | $208.93 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $70.79 / $199.53 / $269.15
| Professional | 52 | $70.79 | $199.53 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $165.96 / $354.81
| Professional | | $69.18 | $165.96 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $257.04 / $524.81
| Professional | | $87.10 | $257.04 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $407.38
| Professional | | $87.10 | $194.98 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $181.97 / $323.59
| Facility | | $61.66 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $489.78
| Professional | | $120.23 | $120.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $100.00 / $288.40
| Professional | | $91.20 | $100.00 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $776.25 / $1,949.84
| Facility | | $173.78 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $165.96 / $371.54
| Professional | | $67.61 | $165.96 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $4,365.16 / $4,365.16
| Facility | | $56.23 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Facility | 52 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,584.89
| Professional | | $1,380.38 | $1,380.38 | $1,584.89 |