- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,344.23 / $6,918.31
| Facility | | $512.86 | $2,344.23 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $457.09 / $707.95 / $1,318.26
| Facility | 52 | $457.09 | $707.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $323.59 / $1,778.28
| Professional | | $141.25 | $323.59 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $4,897.79 / $10,964.78
| Facility | | $1,621.81 | $4,897.79 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $407.38 / $1,778.28
| Professional | | $169.82 | $407.38 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $1,148.15 / $4,570.88
| Facility | | $257.04 | $1,148.15 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | 22 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | 52 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $2,238.72
| Professional | | $165.96 | $371.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $2,511.89 / $6,025.60
| Facility | | $776.25 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $275.42 / $1,862.09
| Professional | | $138.04 | $275.42 | $1,862.09 |