- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $2,089.30 / $5,623.41
| Facility | | $389.05 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | 52 | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $239.88 / $870.96
| Professional | | $67.61 | $239.88 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $229.09
| Professional | | $64.57 | $114.82 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,548.82 / $3,235.94
| Facility | | $758.58 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $316.23 / $562.34
| Professional | | $158.49 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $407.38 / $602.56
| Professional | | $131.83 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,630.27 / $4,677.35
| Facility | | $1,698.24 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $309.03 / $645.65
| Professional | | $151.36 | $309.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $389.05 / $1,659.59
| Facility | | $141.25 | $389.05 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | 52 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | 53 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $524.81 / $2,754.23
| Professional | | $190.55 | $524.81 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,148.15 / $2,691.53
| Facility | | $724.44 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $323.59 / $645.65
| Professional | | $134.90 | $323.59 | $645.65 |