- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,311.31 / $8,511.38
| Facility | | $707.95 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $602.56 / $1,230.27
| Professional | | $257.04 | $602.56 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $346.74 / $467.74
| Professional | | $223.87 | $346.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,995.26 / $11,220.18
| Facility | | $616.60 | $1,995.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $575.44 / $758.58
| Professional | | $239.88 | $575.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $2,137.96
| Facility | | $436.52 | $630.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 22
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 22 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 52 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Facility | 53 | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $537.03 / $1,122.02
| Professional | | $269.15 | $537.03 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $4,365.16 / $8,912.51
| Facility | | $2,454.71 | $4,365.16 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $549.54 / $831.76
| Professional | | $302.00 | $549.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $194.98 / $812.83
| Professional | | $32.36 | $194.98 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $3,090.30 / $6,760.83
| Facility | | $707.95 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $501.19 / $1,000.00
| Professional | | $234.42 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $489.78 / $741.31
| Professional | | $194.98 | $489.78 | $741.31 |