- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $1,819.70 / $3,630.78
| Facility | | $239.88 | $1,819.70 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $186.21 / $645.65
| Professional | | $36.31 | $186.21 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $524.81 / $2,691.53
| Facility | | $56.23 | $524.81 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 52 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $204.17 / $676.08
| Professional | | $39.81 | $204.17 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $97.72
| Facility | | $41.69 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $234.42 / $489.78
| Professional | | $41.69 | $234.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $676.08 / $741.31
| Facility | | $229.09 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $223.87 / $549.54
| Professional | | $45.71 | $223.87 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $3,311.31
| Facility | | $33.88 | $48.98 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $549.54
| Professional | | $269.15 | $380.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,819.70 / $3,467.37
| Facility | | $229.09 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $223.87 / $645.65
| Professional | | $41.69 | $223.87 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $645.65 / $676.08
| Facility | | $457.09 | $645.65 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $1,905.46 / $4,570.88
| Professional | | $275.42 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $524.81 / $2,691.53
| Facility | | $56.23 | $524.81 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 52 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $204.17 / $676.08
| Professional | | $39.81 | $204.17 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $1,000.00 / $2,754.23
| Facility | | $309.03 | $1,000.00 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $194.98 / $676.08
| Professional | | $41.69 | $194.98 | $676.08 |