- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $1,995.26 / $5,623.41
| Facility | | $363.08 | $1,995.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $416.87 / $933.25
| Professional | | $194.98 | $416.87 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $154.88 / $239.88 / $977.24
| Professional | 52 | $154.88 | $239.88 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $204.17 / $524.81
| Professional | 53 | $63.10 | $204.17 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $239.88
| Professional | | $162.18 | $223.87 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $173.78
| Professional | 52 | $50.12 | $50.12 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | 53 | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,511.89 / $5,011.87
| Facility | | $1,479.11 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $562.34
| Professional | | $208.93 | $245.47 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $309.03
| Facility | | $181.97 | $239.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $457.09 / $602.56
| Professional | | $257.04 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $1,659.59
| Facility | | $338.84 | $338.84 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 22 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 52 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | 53 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $3,162.28
| Professional | | $218.78 | $478.63 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $2,089.30 / $4,168.69
| Facility | | $524.81 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $691.83
| Professional | | $199.53 | $398.11 | $691.83 |