- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $575.44 / $4,897.79
| Facility | | $79.43 | $575.44 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $165.96 / $407.38
| Professional | | $75.86 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $154.88
| Professional | | $63.10 | $93.33 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $1,202.26
| Facility | | $70.79 | $131.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $199.53
| Professional | | $70.79 | $131.83 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $281.84 / $645.65
| Facility | | $125.89 | $281.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 52 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $154.88 / $354.81
| Professional | | $79.43 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $275.42
| Professional | | $100.00 | $169.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $87.10 / $223.87
| Professional | | $32.36 | $87.10 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $398.11 / $398.11
| Facility | | $158.49 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $138.04 / $309.03
| Professional | | $67.61 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $120.23 / $165.96
| Professional | | $58.88 | $120.23 | $165.96 |