- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $2,511.89 / $8,709.64
| Facility | | $316.23 | $2,511.89 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 52 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $4,677.35
| Professional | | $194.98 | $478.63 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $5,888.44 / $13,489.63
| Facility | | $3,162.28 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $257.04 / $489.78
| Professional | | $194.98 | $257.04 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $1,778.28
| Facility | | $363.08 | $707.95 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 22 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 52 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | AS | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $616.60
| Professional | | $204.17 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $478.63
| Professional | | $173.78 | $257.04 | $478.63 |