- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $630.96 / $5,011.87
| Facility | | $114.82 | $630.96 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $281.84 / $933.25
| Professional | | $74.13 | $281.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | 52 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $275.42 / $275.42
| Professional | 53 | $21.38 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $660.69
| Professional | | $181.97 | $281.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $354.81 / $660.69
| Professional | | $100.00 | $354.81 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $562.34 / $3,467.37
| Facility | | $199.53 | $562.34 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 52 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 53 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $912.01
| Professional | | $208.93 | $371.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $478.63 / $645.65
| Professional | | $190.55 | $478.63 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $645.65
| Professional | | $213.80 | $269.15 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $398.11 / $660.69
| Professional | | $3.02 | $398.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,819.70 / $5,128.61
| Facility | | $1,000.00 | $1,819.70 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $229.09 / $562.34
| Professional | | $89.13 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $181.97 / $501.19
| Professional | | $154.88 | $181.97 | $501.19 |