- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $977.24 / $2,041.74
| Facility | | $89.13 | $977.24 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 52 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $141.25 / $489.78
| Professional | | $61.66 | $141.25 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $93.33
| Professional | | $63.10 | $64.57 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $128.82
| Professional | | $60.26 | $95.50 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $114.82
| Facility | | $74.13 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $134.90 / $181.97
| Professional | | $128.82 | $134.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $120.23 / $223.87
| Professional | | $61.66 | $120.23 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $812.83 / $2,884.03
| Facility | | $89.13 | $812.83 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 52 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $165.96 / $309.03
| Professional | | $72.44 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $112.20 / $239.88
| Professional | | $53.70 | $112.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,584.89 / $3,801.89
| Facility | | $562.34 | $1,584.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $199.53
| Professional | | $67.61 | $125.89 | $199.53 |