- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $501.19 / $5,623.41
| Facility | | $69.18 | $501.19 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $177.83
| Professional | | $44.67 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | 52 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | 53 | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $102.33
| Professional | | $51.29 | $61.66 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $295.12 / $912.01
| Facility | | $229.09 | $295.12 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $141.25
| Professional | | $56.23 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $141.25
| Professional | | $50.12 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $269.15
| Professional | | $64.57 | $114.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $58.88 / $102.33
| Professional | | $53.70 | $58.88 | $102.33 |
- 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
- $173.78 / $691.83 / $2,089.30
| Facility | | $173.78 | $691.83 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $128.82
| Professional | | $51.29 | $81.28 | $128.82 |