- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,089.30 / $5,623.41
| Facility | | $676.08 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 52 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $186.21 / $524.81
| Professional | | $36.31 | $186.21 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $177.83 / $288.40
| Professional | | $30.20 | $177.83 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $1,698.24 / $3,235.94
| Facility | | $416.87 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $208.93 / $398.11
| Professional | | $43.65 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $147.91 / $239.88
| Facility | | $112.20 | $147.91 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $199.53 / $407.38
| Professional | | $38.90 | $199.53 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $199.53 / $512.86
| Facility | | $36.31 | $199.53 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $562.34
| Facility | 52 | $134.90 | $134.90 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $1,659.59
| Professional | | $199.53 | $295.12 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $831.76 / $2,089.30
| Facility | | $213.80 | $831.76 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $177.83 / $346.74
| Professional | | $35.48 | $177.83 | $346.74 |