- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $977.24 / $7,413.10
| Facility | | $100.00 | $977.24 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $331.13
| Facility | 52 | $208.93 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $131.83 / $288.40
| Professional | | $69.18 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $169.82
| Professional | 52 | $64.57 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $79.43
| Professional | 53 | $30.20 | $42.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $138.04
| Professional | | $70.79 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | 53 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $1,230.27
| Facility | | $251.19 | $316.23 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $218.78
| Professional | | $77.62 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $218.78
| Professional | | $74.13 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $151.36 / $398.11
| Professional | | $91.20 | $151.36 | $398.11 |
- 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
- $72.44 / $81.28 / $138.04
| Professional | | $72.44 | $81.28 | $138.04 |
- 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
- $75.86 / $123.03 / $194.98
| Professional | | $75.86 | $123.03 | $194.98 |