- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $2,089.30 / $10,232.93
| Facility | | $120.23 | $2,089.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $141.25 / $338.84
| Professional | | $75.86 | $141.25 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Professional | 52 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $131.83
| Professional | | $79.43 | $102.33 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $2,137.96 / $3,981.07
| Facility | | $707.95 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $177.83
| Professional | | $67.61 | $104.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $245.47
| Professional | | $120.23 | $141.25 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $100.00 / $107.15
| Facility | | $63.10 | $100.00 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $162.18 / $281.84
| Professional | | $131.83 | $162.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $239.88
| Professional | | $81.28 | $131.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $21,379.62
| Facility | | $169.82 | $169.82 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $229.09
| Professional | | $83.18 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $63.10
| Professional | | $32.36 | $33.11 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $245.47
| Facility | | $100.00 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $213.80
| Professional | | $74.13 | $125.89 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $870.96 / $2,951.21
| Facility | | $151.36 | $870.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $186.21
| Professional | | $69.18 | $109.65 | $186.21 |