- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $870.96 / $1,778.28
| Facility | | $57.54 | $870.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $138.04 / $512.86
| Professional | | $61.66 | $138.04 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,348.96 / $3,162.28
| Facility | | $457.09 | $1,348.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $229.09 / $524.81
| Professional | | $117.49 | $229.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $1,288.25
| Facility | | $380.19 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $263.03 / $602.56
| Professional | | $131.83 | $263.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $512.86 / $1,000.00
| Facility | | $416.87 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $512.86
| Professional | | $131.83 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $213.80 / $2,089.30
| Facility | | $77.62 | $213.80 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 52 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $288.40 / $660.69
| Professional | | $144.54 | $288.40 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,238.72 / $5,370.32
| Facility | | $1,174.90 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $436.52
| Professional | | $85.11 | $186.21 | $436.52 |