- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $776.25 / $5,011.87
| Facility | | $144.54 | $776.25 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $741.31 / $2,187.76 / $2,187.76
| Facility | 52 | $741.31 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $144.54 / $416.87
| Professional | | $67.61 | $144.54 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $181.97 / $363.08
| Professional | | $93.33 | $181.97 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $398.11
| Professional | | $112.20 | $162.18 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $181.97 / $758.58
| Facility | | $79.43 | $181.97 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 52 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $229.09 / $363.08
| Professional | | $107.15 | $229.09 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $302.00
| Facility | | $162.18 | $263.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $165.96 / $331.13
| Facility | | $74.13 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $169.82 / $354.81
| Professional | | $79.43 | $169.82 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,398.83 / $2,884.03
| Facility | | $1,737.80 | $2,398.83 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $371.54
| Professional | | $120.23 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,630.27 / $4,897.79
| Facility | | $1,548.82 | $2,630.27 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $338.84
| Professional | | $95.50 | $186.21 | $338.84 |