- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $2,511.89 / $7,244.36
| Facility | | $389.05 | $2,511.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $977.24 / $1,380.38 / $2,398.83
| Facility | 52 | $977.24 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $354.81 / $758.58
| Professional | | $169.82 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $4,265.80 / $9,332.54
| Facility | | $1,513.56 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $676.08
| Professional | | $190.55 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $741.31 / $2,754.23
| Facility | | $295.12 | $741.31 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | 22 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | 52 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | 53 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $831.76
| Professional | | $194.98 | $371.54 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $2,344.23 / $5,623.41
| Facility | | $676.08 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $741.31
| Professional | | $173.78 | $302.00 | $741.31 |