- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $186.21 / $3,890.45
| Facility | | $87.10 | $186.21 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $123.03 / $288.40
| Professional | | $67.61 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $165.96
| Professional | 52 | $89.13 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $72.44
| Professional | 53 | $26.92 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $123.03
| Professional | | $69.18 | $102.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $128.82
| Professional | | $60.26 | $89.13 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $109.65
| Facility | | $56.23 | $81.28 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $128.82
| Professional | | $74.13 | $100.00 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $107.15 / $107.15
| Facility | | $34.67 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | 52 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | 53 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $724.44
| Professional | | $83.18 | $141.25 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $724.44 / $1,949.84
| Facility | | $58.88 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $173.78
| Professional | | $67.61 | $114.82 | $173.78 |