- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $2,238.72 / $5,011.87
| Facility | | $194.98 | $2,238.72 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $275.42 / $1,071.52
| Professional | | $69.18 | $275.42 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 52 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $416.87
| Professional | | $338.84 | $338.84 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $177.83 / $331.13
| Professional | | $75.86 | $177.83 | $331.13 |
- 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
- $66.07 / $165.96 / $309.03
| Professional | | $66.07 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.83 / $97.72 / $309.03
| Professional | | $0.83 | $97.72 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $81.28 / $288.40
| Professional | | $0.72 | $81.28 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $190.55 / $190.55
| Professional | | $53.70 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $977.24 / $2,041.74
| Facility | | $93.33 | $977.24 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $169.82 / $331.13
| Professional | | $61.66 | $169.82 | $331.13 |