- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $6,760.83
| Facility | | $489.78 | $977.24 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $239.88 / $1,318.26
| Professional | | $74.13 | $239.88 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $263.03
| Facility | | $147.91 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $2,187.76
| Professional | | $870.96 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $1,659.59
| Facility | | $257.04 | $257.04 | $1,659.59 |
- 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
- $162.18 / $741.31 / $4,786.30
| Professional | | $162.18 | $741.31 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $5,128.61 / $9,549.93
| Facility | | $691.83 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $186.21 / $288.40
| Professional | | $177.83 | $186.21 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,230.27 / $5,370.32
| Facility | | $1,000.00 | $1,230.27 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $229.09 / $1,174.90
| Professional | | $123.03 | $229.09 | $1,174.90 |