- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $2,511.89 / $6,760.83
| Facility | | $151.36 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $331.13
| Professional | | $97.72 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $309.03
| Professional | 52 | $102.33 | $102.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $263.03 / $380.19
| Professional | | $123.03 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $338.84
| Professional | | $107.15 | $169.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $251.19 / $1,148.15
| Facility | | $131.83 | $251.19 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Facility | 52 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $229.09 / $812.83
| Professional | | $117.49 | $229.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $346.74
| Professional | | $213.80 | $263.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $346.74
| Professional | | $173.78 | $223.87 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $954.99 / $2,344.23
| Facility | | $457.09 | $954.99 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $309.03
| Professional | | $102.33 | $147.91 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $302.00
| Professional | | $204.17 | $257.04 | $302.00 |