- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $1,000.00 / $4,786.30
| Facility | | $66.07 | $1,000.00 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | 52 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $58.88 / $147.91
| Professional | | $25.12 | $58.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $70.79 / $112.20
| Professional | | $33.88 | $70.79 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $2,398.83 / $4,168.69
| Facility | | $794.33 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $141.25
| Professional | | $34.67 | $72.44 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $47.86
| Facility | | $30.20 | $33.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $79.43 / $131.83
| Professional | | $74.13 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $67.61 / $144.54
| Professional | | $33.11 | $67.61 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $66.07 / $123.03
| Professional | | $23.44 | $66.07 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $42.66
| Professional | 52 | $17.38 | $17.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $125.89 / $151.36
| Professional | | $100.00 | $125.89 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $1,318.26 / $2,344.23
| Facility | | $213.80 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $64.57 / $144.54
| Professional | | $28.84 | $64.57 | $144.54 |