- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,584.89 / $4,897.79
| Facility | | $707.95 | $1,584.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $234.42 / $512.86
| Professional | | $69.18 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $165.96 / $234.42
| Facility | | $134.90 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $389.05 / $794.33
| Professional | | $323.59 | $389.05 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $1,659.59
| Facility | | $234.42 | $234.42 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 22 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 52 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | 53 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $363.08 / $1,737.80
| Professional | | $151.36 | $363.08 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,454.71 / $5,370.32
| Facility | | $676.08 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | 52 | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $177.83 / $263.03
| Professional | | $162.18 | $177.83 | $263.03 |
- 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
- $117.49 / $269.15 / $537.03
| Professional | | $117.49 | $269.15 | $537.03 |