- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $776.25 / $8,511.38
| Facility | | $89.13 | $776.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $102.33 / $446.68
| Professional | | $41.69 | $102.33 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $93.33
| Professional | | $70.79 | $70.79 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $436.52 / $851.14
| Facility | | $331.13 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $162.18 / $398.11
| Professional | | $48.98 | $162.18 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $213.80 / $616.60
| Professional | | $83.18 | $213.80 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $331.13 / $645.65
| Facility | | $57.54 | $331.13 | $645.65 |
- 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
- $213.80 / $371.54 / $2,089.30
| Professional | | $213.80 | $371.54 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $389.05 / $562.34
| Professional | | $83.18 | $389.05 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $354.81 / $676.08
| Professional | | $95.50 | $354.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $1,548.82 / $4,466.84
| Facility | | $263.03 | $1,548.82 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $213.80 / $489.78
| Professional | | $57.54 | $213.80 | $489.78 |