- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $602.56 / $7,762.47
| Facility | | $77.62 | $602.56 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $223.87 / $537.03
| Professional | | $63.10 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $70.79 / $194.98 / $251.19
| Professional | 52 | $70.79 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $758.58
| Facility | | $234.42 | $398.11 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $144.54 / $251.19
| Professional | | $54.95 | $144.54 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $169.82
| Facility | | $131.83 | $131.83 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $181.97 / $354.81
| Professional | | $81.28 | $181.97 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $181.97 / $436.52
| Facility | | $72.44 | $181.97 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,122.02 / $4,677.35
| Facility | | $199.53 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $154.88 / $302.00
| Professional | | $63.10 | $154.88 | $302.00 |