- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $707.95 / $3,890.45
| Facility | | $40.74 | $707.95 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $114.82 / $446.68
| Professional | | $41.69 | $114.82 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $125.89 / $199.53
| Facility | | $1.00 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $251.19 / $724.44
| Professional | | $77.62 | $251.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $794.33 / $1,905.46
| Facility | | $501.19 | $794.33 | $1,905.46 |
- 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
- $61.66 / $199.53 / $794.33
| Professional | | $61.66 | $199.53 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $741.31 / $1,479.11
| Facility | | $602.56 | $741.31 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $346.74 / $724.44
| Professional | | $91.20 | $346.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $218.78 / $630.96
| Facility | | $52.48 | $218.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $2,089.30
| Professional | | $165.96 | $416.87 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,862.09 / $5,370.32
| Facility | | $380.19 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $302.00 / $1,412.54
| Professional | | $72.44 | $302.00 | $1,412.54 |