- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $501.19 / $5,495.41
| Facility | | $190.55 | $501.19 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $245.47 / $478.63
| Professional | | $131.83 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $158.49
| Professional | | $128.82 | $128.82 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $218.78 / $323.59
| Professional | | $120.23 | $218.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $194.98
| Facility | | $102.33 | $162.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $229.09 / $316.23
| Professional | | $144.54 | $229.09 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $1,318.26
| Facility | | $223.87 | $223.87 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | 52 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $316.23 / $1,412.54
| Professional | | $158.49 | $316.23 | $1,412.54 |
- 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
- $524.81 / $2,137.96 / $4,168.69
| Facility | | $524.81 | $2,137.96 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $234.42 / $446.68
| Professional | | $128.82 | $234.42 | $446.68 |