- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $467.74 / $6,918.31
| Facility | | $125.89 | $467.74 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 52 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $173.78 / $380.19
| Professional | | $64.57 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $70.79 / $190.55 / $208.93
| Professional | 52 | $70.79 | $190.55 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $158.49 / $295.12
| Professional | | $67.61 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $323.59 / $1,047.13
| Professional | | $66.07 | $323.59 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $173.78 / $331.13
| Professional | | $72.44 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $229.09 / $616.60
| Professional | | $52.48 | $229.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $478.63
| Professional | | $208.93 | $263.03 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $190.55 / $363.08
| Facility | | $72.44 | $190.55 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $1,659.59
| Facility | | $61.66 | $93.33 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $1,659.59
| Professional | | $165.96 | $263.03 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,344.23
| Facility | | $204.17 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $141.25 / $338.84
| Professional | | $60.26 | $141.25 | $338.84 |