- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $407.38 / $7,079.46
| Facility | | $87.10 | $407.38 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $208.93
| Professional | | $67.61 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $70.79 / $95.50
| Professional | 52 | $69.18 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $69.18
| Professional | 53 | $24.55 | $31.62 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $162.18
| Professional | | $64.57 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $323.59 / $1,047.13
| Professional | | $70.79 | $323.59 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $190.55
| Professional | | $74.13 | $120.23 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $114.82 / $302.00
| Professional | | $52.48 | $114.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $239.88
| Professional | | $151.36 | $190.55 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $120.23 / $190.55
| Facility | | $63.10 | $120.23 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $1,659.59
| Facility | | $64.57 | $109.65 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $1,659.59
| Professional | | $97.72 | $141.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $1,047.13 / $2,344.23
| Facility | | $204.17 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $181.97
| Professional | | $63.10 | $114.82 | $181.97 |