- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $2,344.23 / $6,309.57
| Facility | | $446.68 | $2,344.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $338.84
| Professional | | $93.33 | $138.04 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $309.03
| Professional | 52 | $102.33 | $131.83 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $190.55
| Professional | | $83.18 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $190.55
| Professional | | $109.65 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $234.42
| Professional | | $109.65 | $151.36 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $741.31
| Facility | | $97.72 | $162.18 | $741.31 |
- 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 / $186.21 / $954.99
| Professional | | $117.49 | $186.21 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $549.54 / $1,698.24
| Facility | | $245.47 | $549.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $218.78
| Professional | | $97.72 | $141.25 | $218.78 |