- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $2,691.53 / $6,760.83
| Facility | | $208.93 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $691.83
| Professional | | $123.03 | $251.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $165.96 / $524.81
| Professional | | $158.49 | $165.96 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $776.25
| Professional | | $208.93 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $309.03 / $537.03
| Professional | | $169.82 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $251.19 / $537.03
| Facility | | $131.83 | $251.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $616.60
| Professional | | $302.00 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $389.05
| Professional | | $186.21 | $204.17 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $3,890.45 / $6,760.83
| Facility | | $1,380.38 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $269.15 / $524.81
| Professional | | $141.25 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,786.30 / $4,786.30 / $19,498.45
| Facility | | $4,786.30 | $4,786.30 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 52 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $2,089.30
| Professional | | $1,819.70 | $1,819.70 | $2,089.30 |