- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $933.25 / $3,311.31
| Facility | | $407.38 | $933.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $407.38 / $831.76
| Professional | | $190.55 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $1,000.00
| Professional | 52 | $154.88 | $213.80 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $37.15 / $64.57 / $89.13
| Professional | 53 | $37.15 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $416.87
| Professional | | $151.36 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | 52 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $190.55 / $223.87 / $426.58
| Professional | 53 | $190.55 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $758.58
| Facility | | $691.83 | $691.83 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Professional | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $1,380.38
| Facility | | $512.86 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $416.87 / $794.33
| Professional | | $213.80 | $416.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,479.11 / $2,884.03
| Facility | | $616.60 | $1,479.11 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $398.11 / $851.14
| Professional | | $186.21 | $398.11 | $851.14 |