- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $2,818.38 / $9,549.93
| Facility | | $489.78 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $616.60 / $1,230.27
| Professional | | $257.04 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- 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
- $269.15 / $354.81 / $588.84
| Professional | | $269.15 | $354.81 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $269.15 / $794.33
| Facility | | $239.88 | $269.15 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $302.00
| Professional | | $269.15 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $1,047.13
| Facility | | $436.52 | $602.56 | $1,047.13 |
- 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 / $562.34 / $1,148.15
| Professional | | $269.15 | $562.34 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $616.60 / $2,454.71
| Facility | | $436.52 | $616.60 | $2,454.71 |
- 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
- $263.03 / $524.81 / $1,096.48
| Professional | | $263.03 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $245.47
| Professional | | $32.36 | $33.11 | $245.47 |
- 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
- $234.42 / $676.08 / $1,071.52
| Professional | | $234.42 | $676.08 | $1,071.52 |
- 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
- $245.47 / $524.81 / $1,023.29
| Professional | | $245.47 | $524.81 | $1,023.29 |