- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $331.13 / $7,943.28
| Facility | | $85.11 | $331.13 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $66.07 / $194.98
| Professional | | $25.70 | $66.07 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $114.82 / $151.36
| Professional | | $38.90 | $114.82 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $912.01
| Facility | | $354.81 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $117.49
| Professional | | $28.84 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $77.62 / $186.21
| Professional | | $53.70 | $77.62 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $114.82 / $309.03
| Facility | | $38.90 | $114.82 | $309.03 |
- 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
- $77.62 / $128.82 / $549.54
| Professional | | $77.62 | $128.82 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $134.90 / $177.83
| Professional | | $53.70 | $134.90 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $138.04
| Professional | | $54.95 | $54.95 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $36.31 / $165.96
| Professional | | $3.02 | $36.31 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $1,047.13 / $3,801.89
| Facility | | $165.96 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $147.91
| Professional | | $34.67 | $72.44 | $147.91 |