- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $302.00
| Professional | | $93.33 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $43.65 / $102.33 / $165.96
| Professional | 52 | $43.65 | $102.33 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $380.19 / $776.25
| Facility | | $125.89 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $257.04
| Professional | | $181.97 | $218.78 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $204.17
| Professional | | $112.20 | $158.49 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $338.84
| Facility | | $109.65 | $165.96 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $229.09 / $295.12
| Professional | | $144.54 | $229.09 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $43.65 / $102.33 / $165.96
| Professional | 52 | $43.65 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $954.99
| Facility | | $537.03 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $229.09 / $269.15
| Professional | | $177.83 | $229.09 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $436.52
| Professional | | $114.82 | $173.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $218.78
| Professional | | $102.33 | $154.88 | $218.78 |