- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $1,318.26 / $3,981.07
| Facility | | $223.87 | $1,318.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 52 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $309.03 / $1,584.89
| Professional | | $141.25 | $309.03 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $154.88 / $275.42
| Professional | | $66.07 | $154.88 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $281.84
| Professional | | $134.90 | $239.88 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $263.03
| Facility | | $141.25 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,230.27 / $2,089.30
| Professional | | $891.25 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $467.74 / $1,778.28
| Professional | | $158.49 | $467.74 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $1,174.90 / $3,715.35
| Facility | | $194.98 | $1,174.90 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 52 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $316.23 / $1,778.28
| Professional | | $147.91 | $316.23 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $489.78 / $1,412.54
| Professional | | $154.88 | $489.78 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $2,951.21 / $6,165.95
| Facility | | $1,047.13 | $2,951.21 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $269.15 / $1,513.56
| Professional | | $154.88 | $269.15 | $1,513.56 |