- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,089.30 / $6,309.57
| Facility | | $891.25 | $2,089.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $138.04 / $457.09
| Professional | | $41.69 | $138.04 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $37.15 / $93.33
| Professional | | $17.38 | $37.15 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $169.82 / $323.59
| Facility | | $39.81 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $169.82 / $331.13
| Professional | | $35.48 | $169.82 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | 52 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $173.78 / $363.08
| Professional | | $43.65 | $173.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $204.17 / $707.95
| Facility | | $43.65 | $204.17 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 52 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $309.03 / $2,089.30
| Professional | | $181.97 | $309.03 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,047.13 / $2,137.96
| Facility | | $323.59 | $1,047.13 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $165.96 / $338.84
| Professional | | $43.65 | $165.96 | $338.84 |