- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $1,148.15 / $4,570.88
| Facility | | $316.23 | $1,148.15 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $436.52
| Professional | | $112.20 | $234.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $208.93
| Facility | | $120.23 | $147.91 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $302.00 / $616.60
| Professional | | $251.19 | $302.00 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $1,318.26
| Facility | | $204.17 | $204.17 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 22 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | 52 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | 53 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $302.00 / $1,318.26
| Professional | | $134.90 | $302.00 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,454.71 / $4,786.30
| Facility | | $812.83 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | 52 | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $316.23
| Professional | | $134.90 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,230.27 / $2,511.89
| Facility | | $549.54 | $1,230.27 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $446.68
| Professional | | $104.71 | $218.78 | $446.68 |