- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $1,174.90 / $5,623.41
| Facility | | $77.62 | $1,174.90 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $131.83 / $239.88
| Professional | | $63.10 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $190.55
| Professional | 52 | $69.18 | $109.65 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $75.86
| Professional | 53 | $29.51 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $89.13
| Professional | | $63.10 | $75.86 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,819.70 / $3,981.07
| Facility | | $676.08 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $177.83
| Professional | | $81.28 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $144.54
| Professional | | $57.54 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $131.83 / $218.78
| Professional | | $74.13 | $131.83 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $147.91 / $912.01
| Facility | | $54.95 | $147.91 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 52 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | 53 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $758.58
| Professional | | $100.00 | $158.49 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $549.54 / $1,513.56
| Facility | | $162.18 | $549.54 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $165.96
| Professional | | $74.13 | $107.15 | $165.96 |