- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $602.56 / $4,897.79
| Facility | | $75.86 | $602.56 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $218.78 / $660.69
| Professional | | $75.86 | $218.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $147.91 / $158.49
| Professional | 52 | $45.71 | $147.91 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $1,000.00
| Professional | 53 | $21.38 | $34.67 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $2,238.72 / $5,011.87
| Facility | | $891.25 | $2,238.72 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $316.23 / $776.25
| Professional | | $144.54 | $316.23 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $912.01 / $2,137.96
| Facility | | $630.96 | $912.01 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $398.11 / $954.99
| Professional | | $173.78 | $398.11 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $794.33 / $1,548.82
| Facility | | $630.96 | $794.33 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $426.58 / $831.76
| Professional | | $169.82 | $426.58 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $426.58 / $2,691.53
| Facility | | $75.86 | $426.58 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $912.01
| Professional | | $229.09 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,949.84 / $3,981.07
| Facility | | $1,023.29 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $269.15 / $741.31
| Professional | | $131.83 | $269.15 | $741.31 |