- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $457.09 / $5,370.32
| Facility | | $93.33 | $457.09 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | 52 | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $263.03 / $794.33
| Professional | | $66.07 | $263.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $223.87 / $660.69
| Professional | 52 | $30.20 | $223.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $562.34
| Professional | | $147.91 | $181.97 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $302.00 / $549.54
| Professional | | $81.28 | $302.00 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $416.87 / $1,621.81
| Facility | | $147.91 | $416.87 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 52 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $346.74 / $933.25
| Professional | | $169.82 | $346.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $416.87 / $512.86
| Professional | | $147.91 | $416.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $524.81
| Professional | | $151.36 | $194.98 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $446.68 / $512.86
| Professional | | $5.01 | $446.68 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,023.29 / $2,344.23
| Facility | | $295.12 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $194.98 / $478.63
| Professional | | $72.44 | $194.98 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $416.87
| Professional | | $120.23 | $141.25 | $416.87 |