- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $3,715.35
| Facility | | $229.09 | $478.63 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $186.21 / $524.81
| Professional | | $36.31 | $186.21 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $67.61 / $407.38
| Professional | | $37.15 | $67.61 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $295.12 / $616.60
| Professional | | $57.54 | $295.12 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $575.44
| Facility | | $128.82 | $223.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 52 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $229.09 / $478.63
| Professional | | $44.67 | $229.09 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $173.78 / $380.19
| Facility | | $36.31 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $588.84
| Professional | | $199.53 | $199.53 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $288.40 / $346.74
| Professional | | $52.48 | $288.40 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $549.54 / $1,479.11
| Facility | | $81.28 | $549.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $162.18 / $346.74
| Professional | | $36.31 | $162.18 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $776.25 / $776.25
| Facility | | $56.23 | $776.25 | $776.25 |
- 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
- $1,548.82 / $1,548.82 / $1,862.09
| Professional | | $1,548.82 | $1,548.82 | $1,862.09 |