- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $2,041.74 / $5,754.40
| Facility | | $190.55 | $2,041.74 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $436.52 / $467.74 / $467.74
| Facility | 52 | $436.52 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $229.09 / $660.69
| Professional | | $109.65 | $229.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $125.89 / $169.82
| Professional | | $77.62 | $125.89 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,318.26 / $2,041.74
| Facility | | $707.95 | $1,318.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $263.03 / $380.19
| Professional | | $141.25 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,698.24 / $2,754.23
| Facility | | $302.00 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $281.84 / $537.03
| Professional | | $138.04 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $426.58 / $1,445.44
| Professional | | $165.96 | $426.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $151.36 / $380.19
| Professional | | $144.54 | $151.36 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $416.87
| Professional | | $32.36 | $33.11 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,137.96 / $4,365.16
| Facility | | $776.25 | $2,137.96 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $501.19
| Professional | | $128.82 | $269.15 | $501.19 |