- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $2,290.87 / $5,128.61
| Facility | | $758.58 | $2,290.87 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $724.44
| Professional | | $194.98 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $87.10 / $213.80 / $977.24
| Professional | 52 | $87.10 | $213.80 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $173.78
| Professional | 53 | $95.50 | $162.18 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $338.84
| Facility | | $194.98 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $457.09 / $933.25
| Professional | | $380.19 | $457.09 | $933.25 |
- 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
- $213.80 / $436.52 / $3,162.28
| Professional | | $213.80 | $436.52 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $2,454.71 / $6,760.83
| Facility | | $1,122.02 | $2,454.71 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $3,019.95
| Facility | 52 | $645.65 | $645.65 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $251.19 / $478.63
| Professional | | $223.87 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $190.55
| Professional | 52 | $120.23 | $120.23 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | 53 | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,230.27 / $3,311.31
| Facility | | $724.44 | $1,230.27 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $363.08 / $707.95
| Professional | | $177.83 | $363.08 | $707.95 |