- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $177.83 / $3,801.89
| Facility | | $36.31 | $177.83 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $75.86 / $162.18
| Professional | | $28.84 | $75.86 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $134.90 / $186.21
| Professional | | $56.23 | $134.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $147.91 / $239.88
| Professional | | $25.70 | $147.91 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $154.88 / $1,348.96
| Facility | | $61.66 | $154.88 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | 52 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $138.04 / $354.81
| Professional | | $61.66 | $138.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $141.25 / $186.21
| Professional | | $58.88 | $141.25 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $169.82
| Professional | | $57.54 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $144.54 / $165.96
| Professional | | $3.02 | $144.54 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $1,023.29 / $2,344.23
| Facility | | $199.53 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $69.18 / $173.78
| Professional | | $29.51 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $141.25
| Professional | | $47.86 | $56.23 | $141.25 |