- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $660.69 / $6,165.95
| Facility | | $158.49 | $660.69 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $251.19 / $891.25
| Professional | | $77.62 | $251.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Professional | 52 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $630.96
| Professional | | $128.82 | $245.47 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $213.80 / $537.03
| Professional | | $134.90 | $213.80 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $302.00 / $724.44
| Facility | | $104.71 | $302.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $575.44
| Professional | | $123.03 | $269.15 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Professional | 52 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $398.11 / $436.52
| Facility | | $239.88 | $398.11 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $295.12 / $501.19
| Facility | | $102.33 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $234.42 / $602.56
| Professional | | $79.43 | $234.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,187.76 / $2,691.53
| Facility | | $1,584.89 | $2,187.76 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $645.65
| Professional | | $158.49 | $269.15 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,630.27 / $4,897.79
| Facility | | $1,412.54 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $575.44
| Professional | | $128.82 | $269.15 | $575.44 |