- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $2,041.74 / $8,511.38
| Facility | | $125.89 | $2,041.74 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Facility | 52 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $162.18 / $467.74
| Professional | | $57.54 | $162.18 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $100.00 / $114.82
| Professional | | $50.12 | $100.00 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,949.84 / $3,801.89
| Facility | | $1,513.56 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $269.15
| Professional | | $69.18 | $128.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $338.84
| Professional | | $134.90 | $177.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $199.53 / $1,318.26
| Facility | | $74.13 | $199.53 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 52 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $1,148.15
| Professional | | $151.36 | $275.42 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $269.15 / $389.05
| Professional | | $141.25 | $269.15 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $389.05
| Professional | | $117.49 | $190.55 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,548.82 / $5,248.07
| Facility | | $870.96 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $165.96 / $331.13
| Professional | | $77.62 | $165.96 | $331.13 |