- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $2,344.23 / $8,128.31
| Facility | | $302.00 | $2,344.23 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $331.13 / $707.95
| Professional | | $158.49 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $281.84
| Professional | | $117.49 | $162.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $3,890.45 / $11,220.18
| Facility | | $776.25 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $426.58
| Professional | | $177.83 | $338.84 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,621.81 / $1,905.46
| Facility | | $295.12 | $1,621.81 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 52 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $323.59 / $645.65
| Professional | | $173.78 | $323.59 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $13,489.63 / $23,988.33
| Facility | | $6,456.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $295.12 / $380.19
| Professional | | $281.84 | $295.12 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $467.74
| Professional | | $32.36 | $33.11 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,467.37 / $7,079.46
| Facility | | $1,000.00 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $323.59 / $645.65
| Professional | | $162.18 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $281.84 / $416.87
| Professional | | $131.83 | $281.84 | $416.87 |