- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,778.28 / $8,912.51
| Facility | | $331.13 | $1,778.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $398.11 / $776.25
| Professional | | $181.97 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $204.17
| Professional | | $79.43 | $109.65 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $3,019.95 / $6,165.95
| Facility | | $1,000.00 | $3,019.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $407.38
| Professional | | $199.53 | $251.19 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $316.23
| Professional | | $213.80 | $213.80 | $316.23 |
- 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
- $398.11 / $501.19 / $954.99
| Professional | | $398.11 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $512.86 / $1,047.13
| Facility | | $295.12 | $512.86 | $1,047.13 |
- 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 / $398.11 / $794.33
| Professional | | $213.80 | $398.11 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $891.25 / $1,995.26
| Facility | | $467.74 | $891.25 | $1,995.26 |
- 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
- $151.36 / $354.81 / $707.95
| Professional | | $151.36 | $354.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $223.87
| Professional | | $32.36 | $33.11 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $741.31
| Facility | | $100.00 | $100.00 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $457.09 / $724.44
| Professional | | $181.97 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $2,290.87 / $4,897.79
| Facility | | $724.44 | $2,290.87 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $363.08 / $660.69
| Professional | | $186.21 | $363.08 | $660.69 |